Job Description

Position : Medical Billing Fraud Analyst

Long term Contract through 2027

Greenbelt, MD/ Baltimore, MD (Onsite)

Education: Undergraduate degree preferred.

Job Description:

Under the direction of an Auditor or Senior Auditor, assists in obtaining documents and other information related to cases. Performs research to locate potential witnesses. Conducts in-house, telephone and database research; manages case file. Reports to the Auditor or Senior Auditor on progress. Assists in the preparation of interim and final reports and recommendations.

Review data from vendors who provide health care services paid by the federal government to identify anomalies that might be indicative of improper billing or other types of fraud.

Formulate data runs or inquiries from large Medicare and Medicaid databases to elicit particular billing patterns to analyze and research.

Analyze data and draft written conclusions and recommendations regarding possible fraudulent billing patterns to be further investigated.

Prepare interim and final reports on progress of findings for use by attorneys and supervisory attorneys. Reports shall include significant findings, conclusions, and recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, and other aspects of the case.

Work with the assigned attorneys, supervisory attorneys and/or and investigators to determine applicable administrative statutory and regulatory law and identify possible violations or causes of action.

Develop an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigation. Determine proof required to assist in affixing legal responsibility for litigation, and devise methods for obtaining, preserving, and presenting evidence to greatest effect.

Initiate contacts with federal, state, and local officials, and other organizations, including Medicare and Medicaid contractors, related to the subject of the investigation for the purpose of gathering facts, obtaining records, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives. Examine records, correspondence, audits, or reviews pertaining to the transactions, events, or allegations under investigation. Establish and verify relationships among all facts and evidence obtained and presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary to successful case resolution.

Assist in the compilation and analysis of documents and physical evidence, and creation of charts and graphs for use in hearings, presentations, or trial.

Review defense presentations, expert reports, and arguments.

Create financial damage models for use in litigation.

Participate in negotiations as requested.

Travel with personnel to conduct interviews.

Work with independent experts/consultants.

Required Skills:

Experience in document analysis, particularly in relation to fraud cases.

Two years' experience in performing on-line database research and telephone research.

Working knowledge of various public repositories of information.

Familiarity with specific subject matter helpful - Medicare and Medicaid claims, student loan programs, contracting, etc.

Excellent oral and written communication skills.

Undergraduate degree preferred; familiarity with automated litigation support helpful.

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