CGS Federal (Contact Government Services) ยท 4 months ago
Healthcare Fraud Investigator
United States
Full-time
Remote
Mid Level
$85K/yr - $105K/yr
3+ years expCGS Federal is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The role involves analyzing data for evidence of fraud, waste, and abuse, and advising attorneys on the merits of referrals while ensuring compliance with agency standards.
ConsultingInformation TechnologyLegalProfessional ServicesProject ManagementSoftware
No H1B
Security Clearance RequiredU.S. Citizen Only
Responsibilities
Review, sort, and analyze data using computer software programs such as Microsoft Excel
Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.)
Develop HCF case referrals including, but not limited to:
Ensure that HCF referrals meet agency and USAO standards for litigation
Analyze data for evidence of fraud, waste and abuse
Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence
Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings
Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc
Assist conducting witness interviews and preparing written summaries
Qualification
Required
Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field
Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work
Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc
Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data)
Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy
U.S. Citizenship and ability to obtain adjudication for the requisite background investigation
Experience and expertise in performing the requisite services in Section 3
Must be a US Citizen
Must be able to obtain a favorably adjudicated Public Trust Clearance
Preferred
Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3
Relevant experience working with a federal or state legal or law enforcement entity
Company
CGS Federal (Contact Government Services)
Contact Government Services strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Anthony Miller
Partner, President of Operations
Brian York
Partner, President of Strategy
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