Overview
Remote
$45 - $50
Contract - W2
Contract - 12 Month(s)
Skills
Analytical Skill
Auditing
Communication
Data Visualization
Facets
Health Care
Health Insurance
Law Enforcement
Medical Billing
Microsoft Excel
Microsoft Power BI
Microsoft Technologies
Nursing
Pharmacy
Pivot Table
Presentations
SEQUEL
Workflow
Macros
Job Details
Position: Healthcare Fraud Investigator
Location: Remote
Job Type: W2
Requirements
1. Bachelor Degree or Master Degree. Candidate needs to have CFE or AHFI certification
2. Minimum of 3 years of experience in healthcare, pharmacy technician, claims adjudication, medical billing/coding, nursing or law enforcement.
3. Previous experience working for a health insurance payer.
4. Minimum of 2 years of experience conducting comprehensive investigations, preferably with interaction with state, federal, and local law enforcement agencies.
5. Previous experience with FACETS system.
- Experience working with RATSTATS or similar programs for sampling and extrapolation.
- Proficiency using excel including ability to analyze large data sets to identify trends, anomalies, and opportunities for improvement, using data visualization techniques to present findings effectively
- Ability to use excel or other Microsoft software to automate repetitive processes and enhance existing workflows through advanced Excel features, including macros, pivot tables, complex formulas and power query
- Experience with Microsoft Power BI and knowledge of sequel preferred.
- Excellent verbal, written and presentation skills
- Ability to work with individuals of diverse backgrounds at various levels
- Objective and creative analytical and auditing skills
- Knowledge of various product lines in health care industry
- Strong organizational, interpersonal, and communication skills
- Inquisitive nature with ability to analyze data to metrics
- Knowledge of healthcare payment methodologies
- Knowledge and experience with FACETs or similar claim systems.
- Strong personal and professional ethics
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.