The job below is no longer available.
You might also like
in Metairie, LA
Investigations Consultant - New Orleans, LA
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | Metairie, LA Metairie, Louisiana |
About this job
Position Description:
The Investigations
Consultant, working under the general direction and oversight of the SIU
Manager will: Conduct
complex investigations involving suspected civil or criminal fraud in
connection with the Louisiana Medicaid Program.
Primary Responsibilities:
- Provide oversight for the
effective receipt, research and response to Requests for Information
related to the Louisiana Medicaid program - Manage the effective receipt,
investigation and referral of allegations of fraud, waste and abuse in
connection to the provision of Louisiana Medicaid services. - Together with the Louisiana Compliance
Officer and other key Corporate Responsibility and Compliance staff,
identify gaps and inefficiencies in existing policies and procedures and
suggest effective and efficient solutions. - Provide coordinating oversight of
subcontractors, vendors and downstream entities in connection with
auditing and monitoring activities related to Louisiana Medicaid fraud,
waste and abuse - Act as primary liaison with
Pharmacy Benefit Managers, MEDICs, ZPICs, PSCs, law enforcement,
prosecutors, Administrative Law Judges, and other regulatory agencies in
the area of Louisiana Medicaid fraud, waste and abuse detection,
investigation and reporting - Obtain and analyze claims billing
and payment data as necessary in the course of conducting complex
investigations of allegations of criminal or civil Medicaid fraud - Testify in criminal, civil and/or
administrative proceedings as required. - Interview witnesses who have
knowledge of alleged fraud/abuse activity. - Prepare comprehensive case
investigation reports including evidence and findings.
Requirements
Required Qualifications:
- Bachelor's Degree in Business, Criminal Justice, or related field OR High School Diploma with 6+ years experience working in a Compliance organization, Fraud Investigation Unit, or Law Enforcement Agency.
- 2+ years of experience working in a Compliance organization, Fraud Investigation Unit, or Law Enforcement Agency (Healthcare Fraud experience preferred).
- Previous experience with Government Healthcare programs (Medicare, Medicaid and/or TriCare).
- Healthcare Fraud experience.
- Industry Certification (CFE, AHFI).
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.