Healthcare Fraud Investigator

ROLE

We need an experienced Provider Fraud Analyst (PFA). In this role, you will support the United States Postal Service (USPS), Office of Inspector General (OIG), Office of Investigations (OI). The OI investigates crimes and frauds against the USPS. These efforts contribute to safeguarding the USPS' revenue, assets, and help deter postal crimes. In this role, you will be providing investigative support to USPS-OIG Health Care Fraud Provider investigations within the Northeast, Eastern, and Pacific Area Field Office. As the PFA, you will evaluate, analyze, and render informed opinions on the delivery of healthcare treatments and resulting outcomes. This is a full-time opportunity. We can offer job security and stability, a competitive salary, and a comprehensive benefits package.

Apply today!

RESPONSIBILITIES

• Determine issues of liability and the medical necessity of procedure
• Evaluate use of DRG (Diagnosis Related Group) and/or CPT (Current Procedural Terminology) billing codes
• Interview witnesses
• Complete bank analysis
• Review, organize, and analyze complex and voluminous medical documents
• Develop health care fraud investigations
• Utilize agency-specific and other informational databases
• Develop collaborative case strategies
• Make recommendations by preparing factual analysis of healthcare fraud schemes
• Plan and conduct complex provider fraud investigations
• Define problems, analyze alternatives, and recommend solutions to difficult criminal investigative issues

KNOWLEDGE & SKILLS

• Strong analytical, organizational, and time management skills

BACKGROUND

• 10 years of heath care experience conducting Provider Fraud Investigations

EDUCATION

• Bachelor's degree

LOCATION

• Bedford, TX 76021
• Telecommute Option

CLEARANCE

• U.S. citizenship required since this role supports the U.S. federal government

CLIENT

• United States Postal Service

TRAVEL

• Some travel required

WORK HOURS

• 40 hours per week
• 8 hours per day

EMPLOYMENT CLASSIFICATION

• Employment Classification Eligibility - W2 or 1099

RELOCATION

• Not eligible for relocation benefits

West 4th Strategy is an Equal Opportunity/Affirmative Action (EEO/AA) employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, gender, sexual orientation, ancestry, national origin, age, marital status, mental disability, physical disability, medical condition, pregnancy, political affiliation, military or veteran status, or any other basis prohibited by federal or state law.

Other Considerations: applicants will be subject to a background investigation. Individual's primary workstation is located in an office area. The noise level in this environment is low to moderate. Regularly required to sit for extended periods up to 80% of the time; frequently required to move about to access file cabinets and use office equipment such as PC, copier, fax, telephone, cell phone, etc. Occasionally required to reach overhead, bend, and lift objects of up to 10 lbs. Specific vision abilities required by this job include the use of computer monitor screens up to 80% of the time.