What are the responsibilities and job description for the Fraud Analyst (Medical) position at LHH?
Fraud Analyst (Part-time) – Baltimore, MD
LHH Recruitment Solutions is seeking a diligent and detail-oriented Fraud Analyst to assist in identifying and investigating fraudulent activities related to Medicare and Medicaid claims. This part-time position will support the governmental efforts to ensure the integrity of healthcare claims, working collaboratively with a team of experts to identify irregularities and contribute to the prevention of fraud in the Medicare and Medicaid systems. This is a long-term, part-time assignment.
Key Responsibilities:
- Analyze Medicare and Medicaid claims for signs of fraudulent activity or billing discrepancies
- Review claims, patient records, and supporting documentation to identify patterns of fraudulent behavior
- Investigate and report findings in compliance with government regulations and internal policies
- Collaborate with other team members and departments to ensure efficient and accurate claims processing
- Provide recommendations for claim reviews, audits, and investigations
- Maintain accurate records of investigations and findings, ensuring proper documentation
- Assist in reporting fraud cases to appropriate governmental authorities as required
- Stay updated on changes in Medicare/Medicaid policies and fraud detection techniques
Qualifications:
- Bachelor’s degree in Criminal Justice, Healthcare Administration, or a related field (or equivalent experience)
- Prior experience with Medicare and Medicaid claims or fraud analysis is preferred
- Strong understanding of healthcare fraud schemes, billing practices, and government regulations
- Excellent analytical, investigative, and problem-solving skills
- Detail-oriented with the ability to handle sensitive information confidentially
- Strong written and verbal communication skills
- Proficiency in Microsoft Office Suite and experience with fraud detection or claims management software is a plus
- Experience working with government programs or in a healthcare compliance role
- Knowledge of coding systems used in Medicare/Medicaid claims (e.g., ICD, CPT, HCPCS)
- Utilizing all relevant information to assist in the litigation process of said claims
Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Equal Opportunity Employer/Veterans/Disabled. To visit our website or apply to other jobs online, visit https://www.lhh.com/us/en/solutions/recruitment-solutions/.
