Medicaid Fraud SME – Subject Matter Expert
CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in the UK and U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.
About the Opportunity:
The Medicaid Fraud SME will be responsible for activities related to fraud investigation development
In assuming this position, you will be a critical contributor to meeting CoventBridge Group’s objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Program Integrity Supervisor and will work in our Grove City, OH office or if not local, remotely from a home office.
- Identify proactive data analysis study ideas, working closely with the Data Analysis, Medical Review and Program Integrity teams to ensure actionable leads with ROI that meets CMS requirement
- Develop and coordinate investigative approaches and plans for fraud leads in order to expedite the investigative progress
- Help establish and maintain relationships with State Medicaid Agencies and CMS
- Produce and submit required reports according to pre-established time guidelines
- Support team in meeting quality and production standards
- Monitor security of evidence gathered during the development of fraud investigations
- Ensure departmental compliance with Quality Management System and ISO requirements
- Perform other duties as assigned by the Manager that contribute to task order goals and objectives
Minimum of two (2) years of experience in Medicare or Medicaid fraud investigations including investigation development, data analysis, and problem identification or one (1) year of experience with an advanced degree
- Excellent oral, written and verbal skills.
- Ability to work independently and with minimal supervision.
- Knowledge of statistics, data analysis techniques, and PC skills are preferred.
- Must have and maintain a valid driver’s license issued by the state of residence
- Bachelor’s Degree or equivalent related experience
- Preference will also be given to those individuals that have attained the Certified Fraud Examiners (CFE) designation or Accredited Health Care Fraud Investigator (AHFI)
- Medical, Dental, Vision plans
- Life, LTD and STD paid by the employer
- 401(k) with company match up to 4%
- Paid Time Off and company paid holidays
- Tuition assistance after 1 year of service
*CoventBridge is proud to be an EEO-AA employer M/F/D/V.*
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