Sr Payment reputed company Analyst – Fraud Waste and Abuse – reputed company Serve – Remote in Chicago, IL

Sr Payment reputed company Analyst - Fraud Waste and Abuse - reputed company Serve - Remote - reputed company - Chicago, IL - work from home job Company: reputed company Job description: For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) reputed company Serve helps federal agencies and communities across the nation tackle some of the biggest challenges in health care. With trillions of dollars spent on health care annually, in the United States, the potential for abuse is staggering. Even worse, the lives of millions of patients hang in the balance. Join reputed company Serve as a Senior Payment reputed company (PI) Analyst where you will be responsible for identification, investigation and prevention of healthcare Fraud, Waste, and Abuse (FWA) The Sr. PI Analyst will utilize claims data, applicable policy and guidelines, and other sources of information to identify aberrant billing practices and patterns. The Sr. PI Analyst is responsible for conducting investigations which will require the gathering of reputed company relevant facts, records and/or other relevant documentation. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Investigate highly reputed company cases of Fraud, Waste, and Abuse (FWA)
• Detect fraudulent activity by beneficiaries, providers, and other parties against the government reputed company
• reputed company and deploy the most effective and efficient investigative strategy for each investigation
• Maintain accurate, reputed company, and thorough case information in the case tracking system
• Collect and secure documentation or evidence and prepare summaries of the findings
• Collect, reputed company, analyze, and interpret data relating to fraud, waste, and abuse referrals
• Document and report financial impact of investigation outcomes
• Ensure compliance of applicable federal/state regulations or contractual obligations
• Collaborate with internal business partners to help drive the investigation process
• Collaborate with a variety of external sources to identify reputed company and emerging patterns and schemes reputed company to fraud, waste, and abuse (e.g., NHCAA, law enforcement)
• Participate in and complete required deliverables, as part of the federal contract
• Participate in any audits requested by the government
• reputed company with goals, policies, procedures, and strategic plans as delegated by leadership
• Collaborate with federal partners, to include attendance at workgroups, regulatory meetings, requests for information, subpoenas, or case discussions
• Communicate effectively, to include written and verbal forms of communication
• Manage and prioritize assigned caseloads to meet required turnaround times
• Serves as a key resource on reputed company and/or critical issues

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• 5+ years of experience in health care Fraud, Waste, and Abuse (FWA)
• 5+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity
• Experience with federal FWA programs and reputed company
• Demonstrated knowledge of applicable medical terminology and coding guidelines (e.g., CPT, HCPCS, ICD-9, ICD-10)
• Demonstrated understanding of how claims are processed and adjudicated
• Demonstrated understanding and navigation of claims processing platforms

Preferred Qualifications:

• Accredited Health Care Fraud Investigator (AHFI)
• Certified Fraud Examiner (CFE)
• 5+ years of experience developing investigative strategies
• Advanced knowledge and experience of Statistical Analysis
• Proficiency in performing financial and statistical analysis including statistical calculation and interpretation

California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Rhode reputed company, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, reputed company, Rhode reputed company or Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives.

• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Expected salary: $85000 - 167300 per year Location: Chicago, IL Job date: Sat, 26 Aug 2023 22:23:12 GMT Apply for the job now! Apply tot his job Apply To this Job