Investigation Coordinator II

Orchard • Los Alamitos, CA

8d • Hybrid

About The Position

@Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities. Are you a recent grad with a degree in Criminal Justice, Criminology, or a related field of study? Do you have a high school diploma and have worked in medical claims - especially those involving Medicare and Medicaid? The Intake Investigator position is the perfect opportunity for you to begin your career in healthcare fraud, waste and abuse investigation! As a member of the Dallas, TX based Unified Program Integrity Contractors (UPIC) team, you'll receive extensive training and mentoring in a job where you can make a positive difference in the future of the nation's Medicare and Medicaid programs. The UPIC SW team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering seven states in the southwest region. We're seeking high performing candidates with a track record of exceeding expectations. Candidates possessing strong analytical, communication and MS Office skills are a great fit for this position. Attention to detail and an organized approach to your work are also key traits for success in this position. The selected candidates will work in the Dallas office located just north of the Galleria Dallas.

Requirements

• High school diploma required; Bachelors degree preferred.
• Prior experience with medical claims a plus.
• Ability to work independently with minimal supervision.
• Ability to communicate effectively with all members of the team to which he/she is assigned.
• Ability to grasp and adapt to changes in procedure and process.
• Ability to effectively resolve complex issues.
• Ability to utilize Microsoft Office to include Word, Excel and Outlook at an intermediate level.

Responsibilities

• Assists Investigators in performing in-depth evaluation and making field level judgments related to complaints and proactive leads of potential Medicare fraud investigations that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action.
• Work with the Lead Medical Review nurses to compile and send out overpayment packets to the Medicare Administrative Contractors and providers.
• Coordinate and manage the transition of workloads, and serve as the interface with other entities.
• Creates reports on a monthly and ad hoc basis
• Provides training and technical advice to team members.
• Works with Quality Director/Officer on ISO initiatives to improve operational systems, processes and policies to improve information flow, management reporting, business process and organizational planning.
• Participates and/or leads internal/external committees as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees