Medical Billing Fraud Analyst

Position: Medical Billing Fraud Analyst

Long-term Contract through 2027

Location: Greenbelt, MD/Baltimore, MD (Onsite)

Job Summary

We are seeking a skilled Medical Billing Fraud Analyst to assist in obtaining documents and other information related to cases. The ideal candidate will have experience in document analysis, particularly in relation to fraud cases.

Key Responsibilities

• Assist in obtaining documents and other information related to cases under the direction of an Auditor or Senior Auditor.
• Perform research to locate potential witnesses and conduct in-house, telephone, and database research.
• Manage case files and report progress to the Auditor or Senior Auditor.
• Assist in preparing interim and final reports and recommendations.
• Review data from vendors who provide health care services paid by the federal government to identify anomalies indicative of improper billing or other types of fraud.
• Formulate data runs or inquiries from large Medicare and Medicaid databases to elicit particular billing patterns for analysis and research.
• Analyze data and draft written conclusions and recommendations regarding possible fraudulent billing patterns.
• Prepare interim and final reports on progress of findings for use by attorneys and supervisory attorneys.
• Work with assigned attorneys, supervisory attorneys, and investigators to determine applicable administrative statutory and regulatory law and identify possible violations or causes of action.
• Determine proof required to assist in affixing legal responsibility for litigation and devise methods for obtaining, preserving, and presenting evidence.
• Initiate contacts with federal, state, and local officials and other organizations to gather facts, obtain records, and advance investigative objectives.
• Examine records, correspondence, audits, or reviews pertaining to transactions, events, or allegations under investigation.
• Establish and verify relationships among all facts and evidence obtained and presented to confirm authenticity of documents and corroborate witness statements.
• Assist in the compilation and analysis of documents and physical evidence and creation of charts and graphs for use in hearings, presentations, or trial.
• Review defense presentations, expert reports, and arguments.
• Create financial damage models for use in litigation.
• Participate in negotiations as requested.
• Travel with personnel to conduct interviews.
• Work with independent experts/consultants.

Requirements

• Experience in document analysis, particularly in relation to fraud cases.
• Two years' experience in performing online database research and telephone research.
• Working knowledge of various public repositories of information.
• Familiarity with specific subject matter helpful - Medicare and Medicaid claims, student loan programs, contracting, etc.
• Excellent oral and written communication skills.
• Undergraduate degree preferred; familiarity with automated litigation support helpful.