Fraud and Abuse Specialist
- Qualified candidates must have a high school degree or GED
- Prior front office medical experience, medical case management, and/or medical social work experience a plus
- Must possess professional writiting skills and ability to correspond with professionals both verbally and in writing.
- Strong verbal communications, problem solving, time management and organizational skills
- Ability to accurately type 35 corrected words per minute, and ability to work independently or with a team a must
- Must have strong spreadsheet and database skills as well as excellent attention to detail
- Proficient in Microsoft Word, Excel; proficient in Access a plus
- Communication, Oral - Ability to communicate effectively with others using the spoken word
- Communication, Written - Ability to communicate in writing clearly and concisely
- Organized - Possessing the trait of being organized or following a systematic method of performing a task
- Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
- Time Management - Ability to utilize the available time to organize and complete work within given deadlines
Environmental and Working Conditions:
- Entire work time is conducted in an office setting
Physical and Mental Requirements:
- Must be able to understand and follow complex instructions
- Ability to work independently or with a team a must
LogistiCare is the nation's leading managed healthcare organization specializing in the management of healthcare transportation benefits. LogistiCare s client base consists of state and local government agencies (Medicaid agencies, transit authorities, school boards), managed care organizations and hospitals. LogistiCare is not a provider of transportation vehicles (we do not physically own vehicles). Instead, LogistiCare manages a network of transportation providers and provides the administrative infrastructure to authorize services and provide billing and claims payment functionality allowing LogistiCare to offer a complete outsourcing solution to our clients.
LogistiCare seeks a full-time Fraud and Abuse Specialist. The Fraud and Abuse (F&A) Specialist identifies utilization and billing trends that may signal abusive practices by performing the following duties:
- Reviews a variety of utilization and billing records to identify unusual or suspicious patterns of utilization and billing
- Investigates all issues to confirm the actual utilization
- Reports to senior management the need to address abusive or fraudulent situations
- Performs other duties as assigned
Note: This description is not intended to be all-inclusive. Employee may be requested to perform other duties from time to time.
LogistiCare is an Affirmative Action-Equal Opportunity Employer.