Senior Investigator (Healthcare Fraud)
Job Description As a Senior Investigator, you will investigate suspected incidents of fraud, waste or abuse. This position may be based either in our Towson, MD office or can be worked remotely from home anywhere in the US. Responsibilities: Identify, investigate, analyze and evaluate instances of potential fraud, waste and abuse. Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review. Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation. Conducts investigation-related training. Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. Negotiates settlement agreements to resolve disputes. Maintain current knowledge of relevant laws, regulations and standards. Participates in special projects as required. Requirements: Bachelor's Degree in related discipline, or the equivalent combination of education, professional training and work experience. 5-8 years of related investigative experience. Excellent verbal and written communication skills. Strong listening and observation skills. Attention to detail and high level of accuracy. Effective organizational and prioritization skills with multi-tasking ability Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC) Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC). Company Description Verscend is transforming the business of healthcare by providing data services, analytics, and advanced technologies that answer the industry's most complex challenges. With a focus on reducing risk across all domains of healthcare, Verscend's broad solution suite is designed to help health plans, employers, providers, and other risk bearing entities better understand the health and risk of their populations to improve quality, reduce costs, ensure payment accuracy, and support compliance. From effective population health management, quality reporting, revenue accuracy, and chart retrieval to tackling fraud, waste, and abuse, Verscend is committed to answering the unique challenges of its clients.