Health Care,Litigation/Attorney/In House/Nashville, Tennessee
Location: Nashville, Tennessee
Description: GCC Consulting is in need of Health Care,Litigation/Attorney/In House/Nashville, Tennessee right now, this vacancy will be settled in Tennessee. More complete informations about this vacancy opportunity kindly read the description below. Healthcare Fraud Investigations and Settlements Consultant Duties: The Investigations and Settlements Consultant 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. Will act as a subject matter expert with identifying, communicating and recovering losses as deemed appropriate. Where applicable, will provide testimonials regarding the investigation. May also complete root cause analysis. Will also play an active role in recovery and remediation of losses.
Qualifications:! Undergraduate degree in the area of Criminal Justice or r! elated field; experience may substitute for an undergraduate degree. Law degree is a plus. 3+ years of experience working in fraud investigations (healthcare fraud experience preferred). 3+ years of experience in the health insurance industry preferred. 3+ years of experience within the insurance claims industry preferred. 3+ years of experience with recovery and remediation of losses; experience in negotiations and/or mediations. Previous experience with government healthcare programs preferred (Medicare, Medicaid and/or TriCare). Law enforcement investigation experience, specifically investigating white collar crimes. Clinical experience (LPN or RN) preferred. Certified Coding Specialist preferred. Certified Fraud Examiner preferred. Requires skills and experience in negotiations and/or mediations. An intermediate or better level of proficiency in MS Excel and MS Word. An intermediate or better level of knowledge with Local, State and Federal laws and regulations pertaini! ng to insurance. Must be self-motivated, goal oriented and have the ability to work independently to successfully investigate complex issues. Strong verbal and written communication, time/project management, problem solving, organizational, and analytical skills required. Some travel may be required.
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If you were eligible to this vacancy, please deliver us your resume, with salary requirements and a resume to GCC Consulting.
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This vacancy will be started on: Fri, 03 May 2013 10:22:08 GMT
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