Qualified candidates will possess the following:
Bachelor's degree or equivalent work experience in health care fraud, waste and abuse. May hold advanced certification in work field.
8-10 years of work experience in the healthcare fraud environment.
Expert knowledge of commercial and government insurance programs.
At least 3 years' experience in Medicare, Medicaid or both.
Expert level of understanding and application of healthcare related technologies.
Extensive knowledge and experience with project management, research and problem resolution techniques.
Ability to plan, develop and manage the scope of a complex project/issue with minimal direction from leadership.
Three or more years' experience developing proactive data projects from conception to identification of investigative leads.
Strong proven analytical ability and basic knowledge of statistics and sampling techniques.
Strong computer skills including Microsoft Access, experience in relational data base design, extract and reporting, Excel and the Internet.
Proven ability to work with a variety of systems, sources of data and analytic tools. Three or more years' experience in CMS systems such as OnePI, SAS, EBI, Business Objects and (preferably) the Unified Case Management tool.
Strong communication and organization skills.
All candidates MUST pass a background check and drug screening prior to employment.