Job Details

Healthcare Fraud Analyst

Primary Responsibilities:

  • Perform data analytics to identify fraud, waste or abuse in claims data

  • Responsible
    for investigating, researching and analyzing billing data in order to
    detect fraudulent, abusive or wasteful activities/practices.

  • Proactively identify instances of potential fraud, waste and abuse through data analysis using company system and tool

  • Prepare statistical/financial analysis reports and graphic presentation for notification of findings

  • Use
    knowledge of heath care coding conventions, fraud schemes, general
    areas of vulnerability, reimbursement methodologies and relevant laws to
    find suspicious patterns in claims data and other sources

  • Develop
    and maintain general knowledge healthcare reimbursement policies and
    state and federal regulations related to healthcare fraud and abuse

  • Work cooperatively and constructively with team members, including mentoring, training and assisting team members as required

  • Perform additional duties and projects as assigned by management

  • Maintain security and confidentiality of all protected health information encountered in performance of duties

Required Qualifications:

  • 1+ years of experience working in a healthcare Fraud Investigations role

  • 1+ years of experience within the Health Insurance Claims Industry

Preferred Qualifications:

  • Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar

Some Experience
$50.00 - $150.00 per hour