Investigation Coordinator II
- Job Title
- Investigation Coordinator II
- Job ID
- 27777402
- Work Hybrid
- Yes
- Location
- Easton, MD Hybrid
- Other Location
- Description
-
Investigation Coordinator II
Easton, MD
(Hybrid schedule with 2 days onsite)
@Orchard LLC is retained by a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Our Client is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.Performs in-depth evaluation and makes field level judgments related to complaints and investigative leads of potential fraud investigations (e.g. Medicare and/or Medicaid) that meet established criteria for referral to the appropriate agency(ies) for administrative action or law enforcement.Essential Duties and Responsibilities:- Reviews complaint data, including allegations, subjects of the complaint, and facts of the complaint to ensure case tracking system is correctly populated and updated per pre-established timeframes.
- Maintains data records in the case tracking systems to ensure timely processing of cases.
- Screens incoming fraud leads by extracting information from sites related to the subject(s), utilizing a variety of resources and systems to capture the scope of fraud, and evaluating relevant legislation to draft a case file that is comprehensive and accurate.
- Confers with complainants and beneficiaries, as needed, to obtain clarification regarding complaints and to verify services to assist in drafting contract reports.
- Operates systems to obtain claims, enrollment, and provider/beneficiary information.
- Prepares intake investigation report, collecting all relevant facts, risks, and leads to recommend investigations to Lead Investigator.
- Processes requests for information (RFIs), as needed, to various contractors, reviews information upon receipt, and incorporates findings into audit/investigation file to ensure thorough audit/investigation files are delivered.
- Recommends opportunities to improve fraud audit/investigation processes and procedures ensuring industry best practices are being followed.
Education and/or Experience Required:- Minimum High School Diploma or GED required
- Must have at least 2-4 years of experience doing office related work.
- Financial or reporting skills are highly preferred.
- Healthcare experience preferred.
- Ability to grasp and adapt to changes in procedure and process.
- Ability to effectively resolve complex issues.
- Ability to utilize Microsoft Office to include Word, Excel and Outlook at an intermediate level.
Established in 2010, @Orchard has an exceptional reputation, providing staffing solutions to time-sensitive, talent scarcity issues to deliver better talent management ROI. Our specialty lies in the critical area of program talent acquisition and resource management, not in one narrow skillset, but across many areas of technical and functional delivery. To learn more about our other exciting opportunities, visit our Jobs Page at www.atorchard.com.
