Overview
- Tier One Technologies is looking for a Healthcare Fraud Analyst to work with our direct US Government client. The primary purpose of the position is to evaluate, analyze and render informed opinions on the delivery of healthcare treatments and the resulting outcomes.
- This long-term hybrid contract position will be located in Arlington, VA and requires occasional travel.
- SELECTED CANDIDATES WITHOUT REQUIRED CLEARANCE WILL BE SUBJECT TO A FEDERAL GOVERNMENT BACKGROUND INVESTIGATION TO RECEIVE IT.
Responsibilities
- Provide investigative support to government Health Care Fraud Provider Investigations.
- Assisting in determining issues of liability, medical necessity of a procedure, evaluating the use of DRG (Diagnosis Related Group) and/or CPT (Current Procedural Terminology) billing codes, interviewing witnesses, completing banking analysis, and preparing documents that involve the review of medical documents that may be complex and voluminous in nature.
- Assisting in the proactive development of Health Care Fraud investigations through utilizing agency specific and other informational databases.
Qualifications
- 10+ years of Health Care experience, which includes experience in conducting Provider Fraud investigations or audits.
- Ability to review, organize, and analyze voluminous and complex medical records and other pertinent healthcare and legal documents.
- Demonstrate experience with developing collaborative case strategies and making recommendations by preparing factual analysis of healthcare fraud schemes.
- Demonstrate experience planning and conducting complex provider fraud investigations.
- Ability to define problems, analyze alternatives and recommend solutions to difficult criminal investigative problems or issues.
- Strong analytical, organizational, and time management skills.
- Ability to work irregular hours (including nights and weekends) as needed without any additional premium pay.
- Ability to travel occasionally in order to provide support to the lead case agent on a case.
- A valid driver's license.
- All candidates must be a US Citizen or have permanent residence status (Green Card).
- Candidate must have lived in the United States for the past 5 years.
- Cannot have more than 6 months travel outside the United States within the last 5 years. Military Service excluded.
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