Excellent Benefits Package!!!
Projected Hiring Range: $42,940 - $45,200
Closing Date: Open Until Filled
Primary Purpose of Position: This position will assist in the development, implementation, revision, maintenance, and promotion of the agency’s fraud, waste, and abuse prevention and detection activities in an effort to ensure that the agency and the agency’s network operates in a manner that is in compliance with applicable State and Federal regulations, agency policies, national accreditation, and Medicaid guidelines. This position will perform functions relating to data analysis, investigations, and auditing relating to the monitoring, detection, and resolution of healthcare fraud, waste, and abuse.
Role and Responsibilities:
Knowledge, Skills and Abilities:
Education and Experience Required:
Bachelor’s Degree in a Human Services field, Health Administration, health informatics/analytics, or related field. Minimum of three (3) years recent experience in MH/DD/SU, with compliance monitoring, auditing or investigation experience.
Education and Experience Preferred:
5 years recent experience in MH/DD/SU, experience analyzing complex data, claims processing, utilization reviews, provider credentialing/monitoring, and/or fraud and abuse detection. Preferred credentials: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), and/or certified as an investigator/inspector through the Council on Licensure, Enforcement, and Regulation (CLEAR). Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) certification. Licensed Clinical Social Worker, Licensed Clinical Addiction Specialist, or another clinical license related to the MH/IDD/SU field. Experience with statistical methods preferred.
Licensure/Certification Requirements: N/A