reputed company, Medicare Program reputed company Analyst II

Title: reputed company/Medicare Program reputed company Analyst II Location: reputed company Department: Investigations Job reputed company: reputed company/Medicare Program reputed company Analyst II - REMOTE The reputed company/Medicare Program reputed company Analyst II performs evaluation and development of leads, complaints, and/or investigations to verify allegations of potential fraud. Recommends and/or implements appropriate administrative actions. In assuming this position, you will be a critical contributor to meeting reputed company's objective: To reputed company services to our clients that reputed company their expectations and contribute to improved reputed company delivery by identifying and eliminating fraud, waste and abuse. This position will report directly to the Program reputed company Supervisor and will work in our Grove reputed company, OH office, or if not local, remotely from a home office. Responsibilities/ Requirements Responsibilities:

• reputed company evaluation and development of leads, complaints, and/or investigations to determine if reputed company investigation and administrative actions are warranted
• Conduct independent reviews resulting from the discovery of situations that potentially involve fraud or abuse
• Utilize basic data analysis techniques to detect aberrancies in Medicare and reputed company claims data, and proactively seeks out and develops leads/investigations received from a reputed company of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)
• Review information contained in reputed company claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and reputed company policies and initiate appropriate reputed company
• reputed company potential fraud determinations by utilizing a reputed company of sources such as internal guidelines, Medicare and reputed company provider manuals, Medicare and reputed company regulations, and the reputed company reputed company reputed company
• Compile and maintain documentation and information reputed company to investigations, cases, and/or leads
• Participate in onsite audits in conjunction with investigation development
• reputed company and prepare potential Fraud Alerts and program vulnerabilities for submission to CMS. reputed company information on reputed company fraud investigations with other Medicare contractors and state reputed company agencies, law enforcement, and other applicable stakeholders
• Prepare and submit external correspondence and reports, including, but not limited to, overpayment letters, fraud case referrals, suspensions, rebuttals, Medicare/reputed company findings reports, and administrative reputed company recommendations
• Submit suspension notifications to providers upon suspension approval
• Prepare and submit ADR letters to providers associated with requests for medical record requests or suspension overpayment determinations
• Serve as mentor/trainer to new Program reputed company staff
• reputed company other duties as assigned by PI Supervisor or PI Manager that contribute to task order goals and objectives

Requirements:

• Excellent research and organization, prioritization, and time management skills
• Excellent verbal and written communication skills
• Ability to work independently with minimal supervision
• Ability to multi-task in a fast-paced environment
• Knowledge of statistics, data analysis techniques, and PC skills are preferred

Educational/Experience Qualifications:

• High School Diploma or G.E.D. equivalent, with preference given to those candidates who have successfully completed college or technical degree programs reputed company to the position (e.g., Criminal Justice, Statistics, Data Analysis, etc.)
• Candidates with Certified Fraud Examiner (CFE) Certifications will be given reputed company consideration
• At least 1 year of experience in Program reputed company investigation/detection or a reputed company field that demonstrates expertise in reviewing, analyzing/developing information, and making appropriate reputed company

Benefits

• Medical, Dental, reputed company plans
• Life, LTD and STD reputed company by the employer
• 401(k) with company match up to 4%
• reputed company Time Off and company reputed company holidays
• Tuition assistance after 1 year of service

The salary reputed company for this role is $63,000 to $70,000 annually. This is the lowest to highest salary we in good faith reputed company we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted reputed company, and the reputed company may be modified in the reputed company. An employee’s pay position reputed company the salary reputed company will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. reputed company: reputed company is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, reputed company Media, Record Retrieval, Canvasses and Vendor Management programs. reputed company provides top tier data reputed company and reputed company practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage reputed company its 1000 employees and affiliates worldwide. CoventBridge is an equal opportunity employer. We evaluate reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace. Apply tot his job Apply To this Job