Vacancy expired!
- BS 10-12, MS 8-10, Phd 5-7
- At least 5 years of relevant investigative experience required.
- Telework in Eastern Time Zone
- Knowledge of Medicare requirements, laws, rules and regulations related to payment for services billed the Program
- CFE or AHFI certification preferred
- Strong communication and organization skills
- Experience in reviewing claims, performing medical review, and/or developing fraud cases
- Strong PC knowledge and skills
- There may be multiple of these individuals for a task order and they may lead significantly different activities
- Examples of Team Leads responsibilities include:
- Assist team members with workflow development
- Review individual workload during monthly meetings; assist with prioritization and conduct QC for staff
- Monitor the quality of WMM/FID
- Monitor timeliness for case updates and escalating to management as necessary
- Monitor the progress ofinvestigations and cases to ensure use of all available remedies, i.e., suspension, pre-pay reviews, revocation, etc.
- Mentor team members so that they can identify previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
- Ability to perform research and draw conclusions
- Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
- Ability to organize a case file, accurately and thoroughly document all steps taken
- Ability to compose correspondence, reports and referral summary letters
- Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters
- Ability to communicate effectively, internally and externally
- Ability to interpret laws and regulations
- Ability to handle confidential material
- Ability to report work activity on a timely basis
- Ability to work independently and as a member of a team to deliver high quality work
- Ability to attend meetings, training, and conferences, overnight travel required
- Document QC results in WMM according to record type
- Act as a point of contact for manager
- Coordinate with other designated leads if necessary, for coverage for periods where the lead is out of the office during work hours.
Vacancy expired!