Fraud Analyst

Davita Inc.; Baltimore (MD); On-site; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare company in Baltimore is seeking a Fraud Analyst for a critical role focused on identifying anomalies in Medicare and Medicaid billing. The position requires strong document analysis skills and a good understanding of fraud investigation practices. Responsibilities include analyzing data, preparing reports, and collaborating with legal professionals. Candidates should have an undergraduate degree and experience in database research.

Qualifications

• Experience in fraud-related document analysis.
• Two years' experience in online database and telephone research.
• Familiarity with Medicare and Medicaid claims is beneficial.

Responsibilities

• Analyze billing patterns to identify fraud.
• Prepare reports for AUSAs and supervisory attorneys.
• Contact federal/state officials for investigative purposes.

Skills

Document analysis

Database research

Communication skills

Education

Undergraduate degree

Job description

Fraud Analyst opportunity in Baltimore, MD!

*This position is 32 hours/week and will be onsite in Baltimore, MD*

*Candidates will be required to obtain a security clearance*

Job Details:

• 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 AUSAs 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 AUSAs, supervisory AUSAs 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 aU ixing 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 USAO MD personnel to conduct interviews. Work with independent experts/consultants.

Job Requirements:

• 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, DoD contracting, etc.


• Excellent oral and written communication skills.


• Undergraduate degree preferred; familiarity with automated litigation support helpful.

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