Jr. Fraud Investigator
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POST DATE 9/8/2016
END DATE 10/8/2016
NCI Information Systems, Inc.
JOB DESCRIPTIONDesignated a 2016 Military Friendly® Employer
NCI: As the Jr. Fraud Investigator ( Program Integrity Analyst ), you will perform evaluation and development of complaints to determine if referral as an investigation is warranted. In assuming this position, you will be a critical contributor to meeting NCI's mission: To deliver innovative, cost-effective solutions and services that enable our customers to rapidly adapt to dynamic environments.Highlights of Responsibilities:
* Review incoming leads to determine if further investigation is warranted.
* Conduct independent reviews resulting from the discovery of situations that potentially involve fraud, waste, or abuse.
* Utilize basic data analysis techniques to detect aberrancies in Medicare claims data
* Complete written referrals to the PI Supervisor as needed on potential investigations derived from complaint reviews.
* Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare policies and initiates appropriate action.
* Make potential fraud determinations by utilizing a variety of sources such as the ZPIC internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act.
* Compile and maintain various documentation and other reporting requirements.
* High school diploma
* Must have and maintain a valid driver's license issued by the state of residence
Preferred Education and Experience:
* Completion of college or technical degree programs related to the position (e.g. criminal justice, statistics, data analysis, etc.)
* Certified Fraud Examiners (CFE) designation
* Knowledge of statistics, healthcare investigation, data analysis techniques, and PC skills
* Experience in fraud detection and investigation within the Medicare program
* Previous law enforcement experience, especially in the field of investigations
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It is the policy of NCI to provide equal opportunity in recruiting, hiring, training, and promoting individuals in all job categories without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other protected class or category as may be defined by federal, state, or local laws or regulations. In addition, we affirm that all compensation, benefits, company-sponsored training, educational assistance, social, and recreational programs are administered without regard to race, color, religion, national origin, gender, age, disability, genetic information, veteran status, sexual orientation, or gender identity. It is our firm intent to support equal employment opportunity and affirmative action in keeping with applicable federal, state, and local laws and regulations.
The information above has been designed to indicate the general nature and level of work performed by employees within the classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position.
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