[Hiring] reputed company/Medicare Program reputed company Analyst II @reputed company

Role Description 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. This position will report directly to the Program reputed company Supervisor and will work in our Grove City, OH office, or if not local, remotely from a home office.

• reputed company evaluation and development of leads, complaints, and/or investigations to determine if further 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 variety of sources (e.g., CMS, OIG, 1-800-MEDICARE, and fraud alerts)
• Review information contained in standard 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 action
• reputed company potential fraud determinations by utilizing a variety of sources such as internal guidelines, Medicare and reputed company provider manuals, Medicare and reputed company regulations, and the reputed company reputed company Act
• 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 action 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

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

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

Benefits

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

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