Senior Investigator - Special Investigations Unit (SIU), Medicaid - Crestline (Contract Position)

Health Management Associates • ,

5d

About The Position

Crestline Advisors, an HMA Company, founded in 2013, is an industry leader in developing successful RFP responses, establishing and managing healthcare provider networks, and assisting clients with regulatory and contract compliance, accreditation, and business development. With a team possessing 500 years of combined experience, Crestline serves a diverse clientele including health plans, provider organizations, and state agencies. Their expertise in developing winning proposal responses for Medicaid managed care organizations (MCOs) complements HMA's extensive MCO support services. Crestline also provides management and operations support for MCOs, making their deep knowledge and experience a valued resource for HMA's expanding client services.

Requirements

• Bachelor's degree or higher in public administration, health care administration, or other field appropriate to the position and three or more years’ experience conducting healthcare fraud investigations.
• Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.
• Experience working with Medicaid, Medicare, or other publicly funded health programs.
• Experience working with a managed care organization.
• Proficiency in Microsoft Office Suite (Excel, Word, OneNote, Teams, Outlook), Google Sheets, etc.

Nice To Haves

• Certified Coder with at least 5 years of experience in healthcare-related investigations or healthcare audits.
• Knowledge of state and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or Medicaid.
• Knowledge of claims processing activities, systems, and terminology.
• Excellent verbal and written communication skills.

Responsibilities

• Research and review records to identify potential areas of improper claims payment, which might indicate fraud, waste, and abuse (FWA).
• Use designated audit tracking tools and provide findings in an established analytic report format.
• Collaborate and communicate with the investigation departments of our vendors and other partners in the county, state, and federal government, as dictated by the scope of the project.

Benefits

• Consultant position without benefits.
• Consultants are onboarded as 1099 and required to pay their own taxes.
• Consultants may need to provide their own equipment for project use – telephone and laptop.

What This Job Offers

• Career Level: Senior