Provider Fraud Investigator
$53,248–$53,248 year
On-siteLincoln, Nebraska, United States
Job Summary
Conduct investigations and audits of suspected Medicaid provider fraud and program abuse under limited supervision. Prepare investigational reports, compile prosecution materials, and coordinate with the Office of Inspector General, FBI, and other law enforcement agencies. Present cases to prosecutors and provide expert testimony in criminal, civil, and administrative actions. Monitor and enforce Medicaid provider compliance with conditions of participation. Verify that services are appropriately delivered and reimbursed by qualified professionals. Work Monday through Friday from 8:00 AM to 5:00 PM with a hiring rate of $25.606 per hour.
Required Qualifications
- Post high school coursework/training in law enforcement, criminal justice, social/behavioral sciences or health related field, nursing, business or public administration, management, program analysis or evaluation of data systems
- Experience in conducting fraud investigations, administrative investigations, utilization review, data systems, review of records and reports and evaluating their use and effectiveness, policy planning/analysis, casework, nursing, accounting or billing systems
- Valid driver's license or the ability to provide independent authorized transportation
Desired Qualifications
- Bachelor's degree in similar fields (Criminal justice, Law, Social Work, or Investigative Methods) or commiserate experience
- Previous experience working with medical claims payment and adjudication, performing financial auditing of public accounts or medical facilities
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