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Audit/Investigation Coordinator II
Location
United States
Posted
77 days ago
Salary
$36.1K - $53.1K / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Audit/Investigation Coordinator II
Qlarant
Role Description Performs in-depth evaluation and makes field level judgments related to complaints and investigative leads of potential fraud investigations (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or law enforcement. Essential Functions: - Reviews complaint data including allegations, subjects of the complaint, and facts of the complaint to ensure case tracking system is correctly populated and updated per pre-established timeframes. - Maintains data records in the case tracking systems to ensure timely processing of cases. - Screens incoming fraud leads by extracting information from sites related to the subject(s), utilizing a variety of resources and systems to capture the scope of fraud, and evaluating relevant legislation to draft a case file that is comprehensive and accurate. - Confers with complainants and beneficiaries, as needed, to obtain clarification regarding complaints and to verify services to assist in drafting contact reports. - Operates systems to obtain claims, enrollment, and provider/beneficiary information. - Prepares intake investigation report, collecting all relevant facts, risks, and leads to recommend investigations to Lead Investigator. - Processes requests for information (RFIs), as needed, to various contractors, reviews information upon receipt, and incorporates findings into audit/investigation file to ensure thorough audit/investigation files are delivered. - Recommends opportunities to improve fraud audit/investigation processes and procedures ensuring industry best practices are being followed. Level of Supervision Received: Under close supervision, works closely with manager to prioritize efforts. Qualifications - Minimum High School Diploma or GED required. Requirements - 2 - 4 years of experience required; 5 - 7 years preferred. Benefits - Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. - Qlarant is a drug-free workplace. - All offers of employment are contingent upon successful completion of pre-employment background and drug screens.
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