Industry: Professional, Scientific & Technical Services•
5 - 7 years
Posted 179 days ago
The Fraud/Data Analyst will explore new techniques to identify patterns of fraud, waste and abuse and other forms of improper payments. This will include a review of the current fraud control procedures and develop ways to identify and measure the impact of fraud. The Fraud/Data Analyst will analyze Medicaid claims and medical records to determine suspicious patterns of billing and illegal activity. She/He will review claims utilizing records and system reports to determine proper documentation, utilization and appropriateness of services to identify possible fraud and abuse. Further, the Fraud/Data Analyst will work as part of a team to detect fraud, report fraud alert schemes, including providers and supportinvestigation of Medicaid fraud cases. She/He will stay current with fraud trends and analytical procedures. The Medicaid Fraud Analyst will act in concert with the state Fraud Control Units including the Office of Health Insurance Programs, the Office of the Medicaid Inspector General, and where appropriate the Medicaid Fraud Control Unit within the Office of the Attorney General, and state and local authorities.
Required experience criteria:
BA or equivalent + 6 yrs related experience, or MA + 4 yrs related experience
Preferred experience criteria: