Senior Investigator, Investigations Unit

Role Overview

• Administer the fraud, waste, and abuse (FWA) duties at an advanced level
• Ensure effective measures are in place and operating effectively to prevent, detect, and correct fraud, waste, and abuse
• Perform advanced level of fraud investigations and provide regular FWA reporting to regulatory agencies
• Help ensure that appropriate procedures are in place and followed consistently to safeguard assets, verify accuracy and reliability of data, and promote efficient operations
• Contribute to the development and operation of an effective FWA program in accordance with CMS requirements and Federal Sentencing Guidelines
• Prepare reports of audit findings and recommendations
• Educate and coach leaders and staff regarding FWA requirements and complex issues
• Participate in completing required Medicare and Medicaid filings and/or responses for FWA

Requirements

• Minimum 5 years’ experience in compliance and/or audit
• Minimum 1 year experience focused on fraud, waste, and abuse
• CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner) Preferred
• Fraud, waste and abuse experience in Medicaid or Medicare

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• AD&D insurance
• Disability insurance
• Health savings account
• Flexible spending account(s)
• Lifestyle spending account
• Employee assistance program
• Wellness program
• Discounts
• Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
• Strong retirement plan with employer contributions
• Paid time off (PTO)
• Paid State Sick Time
• Paid holidays
• Volunteer time
• Jury duty
• Bereavement leave