Intake Investigator - Medicare Integrity Program
Orchard LLC

Intake Investigator - Medicare Integrity Program
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.

The intake Investigator position is the perfect opportunity for you to begin your career in healthcare fraud, waste and abuse investigation! This Easton, MD based team supports the national Medicare Part D integrity program in independently performing in-depth evaluation and making field level judgments related to complaints and proactive leads of potential Medicare fraud investigations that meet established criteria for referral to the Centers for Medicare & Medicaid for administrative action or to the OIG for criminal action.

For this role, we're seeking high performing candidates with a track record of exceeding expectations. Candidates possessing strong analytical, communication and MS Office skills are a great fit for this position. Attention to detail and an organized approach to your work are also key traits for success in this position. The selected candidates will work in our Easton, MD office. Qlarant employees enjoy a collaborative work environment and a very competitive compensation and benefits program.

Essential Duties and Responsibilities:

• Enters investigative information into the case tracking systems and will meet with Lead Investigators to assign investigations to the Investigative team.
• Works with the team to prioritize complaints for investigations.
• Places potential fraudulent providers on prepay review and monitor adjudication of claims.
• Analyzes data for appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria, requesting additional documentation if necessary.
• Refers all potential adverse decisions to the Lead Investigator/Manager.
• Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, preparing affidavits or supervising the preparation of affidavits as needed.
• Drafts and evaluates investigation reports and promote effective and efficient investigations.
• Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
• Testifies at various legal proceedings as necessary.
• Communicates with beneficiaries and providers as needed to resolve beneficiary complaints and assists providers with medical review status.
• Identifies opportunities to improve processes and procedures.
• Has the responsibility and authority to perform their job and provide customer satisfaction.

Education and/or Experience:
Required:

• An Associate's Degree (OR) two years' experience in a related field that demonstrates expertise in reviewing, analyzing, and making appropriate decisions or equivalent combination of education and experience.
• Intermediate level ability to utilize Microsoft Office to include Word, Excel and Outlook.

Preferred:

• Experience in healthcare programs or fraud investigation/detection
• Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator

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.

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