Healthcare Fraud Investigator

Healthcare Fwa InvestigatorLevels (Investigator, Sr. Investigator, etc) will depend on experience and qualifications.Integrity Advantage is a small woman owned business serving health payers and other entities challenged with the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA). We are growing and looking for dynamic, confident and skilled individuals who want to grow with us. Our current need is a healthcare FWA investigator to assist our clients in identifying potential allegations of fraud, conducting investigations and assisting in the recovery process. This is a client facing position, so phenomenal customer service skills are key to being hired for this position.Essential daily duties and responsibilities:Perform timely, thorough and well documented investigationsMaintain, organize and prioritize leads and investigations of varying complexityGather evidence, research and other information to substantiate or refute allegationsUtilize client's fraud detection solution to identify post-payment or pre-payment opportunities for investigation as well as other applications to perform data mining or track investigative resultsSupport multiple clients with Medicaid, Medicare, Federal Employee and Commercial lines of businessCommunicate status updates to clients as appropriatePrepare well written investigative reports including any findings from medical record reviewsKnowledgeable in using RAT-STATS for statistically valid random samplingAbility to provide support to clients for law enforcement referrals, settlement or legal proceedingsSupport other initiatives, as requiredRequired Education / Licenses / Certifications:Bachelor's degreeAccredited Healthcare Fraud Investigator (AHFI) preferredExperience:At least 2 years of healthcare claims investigation experienceKnowledge, Skills & Abilities:Integrity, accountability and confidenceDemonstrated ability to create solutions to problemsAbility to travel for training events, conferences and provide onsite assistance to clients, when needed (appropriate notice will be provided)Excellent grasp of MS Word, Excel and PowerPointQuickly adapt to different anti-fraud technology solutions including ad-hoc query, analytical and case management applicationsKnowledge of federal and state guidelines as well as ICD, CPT, HCPCS, DRG, and rev codesAbility to demonstrate professionalism as well as written and oral communication skillsAbility to work independently within a remote team, under minimal supervisionBenefits401(k)Dental insuranceHealth insurancePaid time offProfessional development assistanceVision insurance