Audit/Investigation Coordinator II

Evaluate and make field-level judgments on complaints and investigative leads regarding potential Medicare and Medicaid fraud. Review complaint data to ensure case tracking systems are correctly populated, then screen incoming leads by extracting information from relevant sites to capture fraud scope. Confers with complainants and beneficiaries to verify services and draft contact reports, while operating systems to obtain claims and enrollment information. Prepare intake investigation reports collecting relevant facts and risks to recommend investigations to the Lead Investigator. Process requests for information to contractors, incorporating findings into thorough audit files. Recommend opportunities to improve fraud audit and investigation processes. Works under close supervision to prioritize efforts.