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At ForHealth Consulting we partner with purposeful organizations to make the healthcare experience better: more equitable, effective, and accessible. We aim to transform the health care experience to one that addresses the needs and concerns of the individual and is inclusive of all.
If you are interested in using your data analysis skills and your passion for reducing fraud, waste, and abuse in a healthcare program this is an excellent opportunity for you.
Are you looking for a hybrid schedule, state benefits, and meaningful work? Come join our team. ** Hybrid requirement ** - Once a month on site.
GENERAL SUMMARY OF POSITION:
Under the general direction of the Associate Director, or designee, the Fraud Investigator II serves a crucial role in combating fraud, waste and abuse (FWA) within the Medicaid program. Investigations involve extensive research to identify industry trends and patterns which target aberrant billing practices. The Investigator II collaborates with the Associate Director on more complex case reviews as needed, in addition to performing activities related to data mining, data analysis and recoveries. With increasing independence, the Investigator II is assigned to multiple provider types and serves as a senior investigator in the Unit., The Investigator II will coach other investigators on developing techniques to find provider schemes based on federal and state regulations that govern Medicaid.
ResponsibilitiesMAJOR RESPONSIBILITIES:
Consistently apply in-depth knowledge of federal and state regulations and healthcare industry standards.
REQUIRED QUALIFICATIONS:
PREFERRED QUALIFICATIONS:
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** Hybrid requirement ** - Once a month on site.
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