Health Care/Attorney/In House/Nashville, Tennessee occupation at GCC Consulting in Nashville

GCC Consulting is presently looking of Health Care/Attorney/In House/Nashville, Tennessee on Sat, 24 Aug 2013 10:26:15 GMT. Healthcare Provider Settlements Consultant The candidate will be responsible for triaging, investigating and resolving instances of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community. Will be utilizing information from claims data analysis and from tips and complaints from plan members, the medical community and law enforcement agencies to...

Health Care/Attorney/In House/Nashville, Tennessee

Location: Nashville, Tennessee

Description: GCC Consulting is presently looking of Health Care/Attorney/In House/Nashville, Tennessee right now, this occupation will be assigned in Tennessee. Further informations about this occupation opportunity kindly read the description below. Healthcare Provider Settlements Consultant The candidate will be responsible for triaging, investigating and resolving instances ! of healthcare fraud and/or abusive conduct by the medical profession, insured members or the broker community. Will be utilizing information from claims data analysis and from tips and complaints from plan members, the medical community and law enforcement agencies to conduct confidential investigations, document relevant findings and report any illegal activities in accordance with all laws and regulations. May also conduct onsite provider claim and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documents related to the investigation. Act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate. Provide testimonials regarding the investigation. May also complete root cause analysis. Play an active role in recovery and remediation of losses - requires skills and experience in negotiations and/or mediations. Frequently interact with legal teams and C-level individuals with! in provider communities including CFO's and General Counsel's.! Partner with clients and recovery services to maximize offset recoveries while minimizing provider abrasion. Partner with FWA legal and outside counsel on arbitration and civil litigation cases. Deliver recovery savings and continuous improvement in settlement negotiated percentages and reduction in recovery cycle times through process improvements and provider relationships

The candidate should have an undergraduate degree in the area of Criminal Justice or related field. Experience may substitute for an undergraduate degree. Law degree is a plus. Must have 3+ years of experience negotiating settlements with medical providers and practices. Should preferably have 3+ years of experience working in fraud investigations and in the health insurance industry. Must have prior experience in negotiating settlements with medical providers and practices OR other significant experience negotiating/mediating settlements.
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If you were eligible to this occupati! on, please deliver us your resume, with salary requirements and a resume to GCC Consulting.

Interested on this occupation, just click on the Apply button, you will be redirected to the official website

This occupation will be started on: Sat, 24 Aug 2013 10:26:15 GMT



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