- Assists with activities related to outside investigations, including but not limited to potential fraud and abuse issues, which could be either general or targeted. Assists external counsel in identifying and reviewing pertinent documents.
- Participates in activities related to exclusion screening, which applies to new hires, current employees, vendors and providers. Investigates and resolves any potential matches.
- Ensures necessary follow-up takes place to resolve open items and that controls are in place to successfully mitigate business and regulatory compliance risks.
- Completes special projects and reports as needed by the Compliance Department.
- Performs other related duties and activities as required.Qualifications:
- Bachelor’s degree required.
- MBA or advanced Degree/professional certification (CIA/CHC) preferred.
- 2 – 5 years’ experience in healthcare and/or compliance or an advanced degree without experience.
- Previous experience in regulatory/compliance audit preferred.
- Knowledge of statistical auditing methods and Medicaid reimbursement preferred.
- Superior ability to communicate orally and in writing to individuals and groups from varied disciplines and levels of management.
- Strong communication, interpersonal and presentation skills, working with both internal and external individuals and entities.
