Healthcare Fraud Investigator

Healthcare Fraud Investigator at Ardelle Associates Healthcare Fraud Investigator at Ardelle Associates in Orange, New Jersey Posted in 8 days ago.

Type:

full-time

Job Description:

Ardelle Associates is seeking for a Health Care Auditor/Investigator with experience in healthcare fraud and criminal and civil cases; specifically in Healthcare and Government Fraud and Opioid Enforcement matters. to support the U.S. Attorney's Office (USAO) located in Newark, NJ. Duties Performs a variety of ancillary audit-related services in direct support of litigation. Provides general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. Assists with the planning of investigations/audits, including performing quantitative and qualitative analyses to identify potential witnesses and relevant documents, to include financial documents. Determines applicable administrative statutory and regulatory law, and identifies possible violations or causes of action.

• Reviews all applicable laws and evidence, providing insights to assist in affixing legal responsibility for litigation while allowing final decisions on investigations and evidence presentation methods to be made by the appropriate authorities Reviews and advises on effective methods for planning, scheduling, and conducting investigations, and identifies any necessary resources Analyzes, organizes, and presents a large volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence, etc.

, Initiates contacts with federal, state, and local officials, and other organizations and individuals related to the subject of investigation, for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives. Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.

• Utilizes electronic databases to identify assets, documents, and other physical evidence.
• Arranges for secure storage, preservation, organization and indexing of voluminous documentary evidence, including electronic storage. Identifies the need for service of subpoenas Reviews, analyzes, and summarizes documents. Analyzes an individual or corporation's ability to pay monetary penalties based on financial disclosures and independent investigation of assets and liabilities.
• Prepares interim and final reports on progress of investigations including significant findings and conclusions, recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of case.

Assists in compilation of documents, data, and physical evidence, and creation of charts, graphs, summaries, videotapes, and other audio-visual materials in presentations, motions, or at trial. Provides advice on selection of witnesses. Provides specialized investigative analysis relevant to Healthcare and Government Fraud matters. Recommends further courses of action such as closing of the case, further investigation, and institution of civil proceedings. Analyzes Medicare Part A, Part B, and Part D databases and Medicaid claims databases. Designs data techniques for fraud detection with Medicare/Medicaid and other databases. Develops data techniques to demonstrate and prove fraud in health care fraud cases. Qualifications Bachelor's degree or higher. At least five (5) years of demonstrated ability in investigating Healthcare or Government Fraud or in finance, accounting, fraud examination or statistical/data analysis. Knowledge of Medicare reimbursement program, CPT Codes, and common healthcare and/or government fraud schemes . U.S. Citizenship and ability to obtain adjudication for the requisite background investigation

Job Types:

Contract, Full-time Pay:

$46.53

• $51.

62 per hour (pay is negotiable)

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person