Job Description

This is an hourly contract position.

Crestline Advisors, an HMA Company, was founded in 2013 and has since become an industry leader in developing successful RFP responses, as well as establishing and managing healthcare provider networks. Their expert consultants also assist clients with regulatory and contract compliance, accreditation, and business development.

The team at Crestline Advisors has a combined 500 years of experience in the field. With a wide range of clients including health plans, provider organizations and state agencies, Crestline has the depth of experience HMA clients have come to expect.

In particular, Crestline’s ability to consistently develop winning proposal responses for Medicaid managed care organizations (MCOs) complements HMA’s extensive MCO supports. Crestline provides management and operations support services for MCOs as well. As HMA continues to expand the ways in which we serve our clients, Crestline’s deep knowledge and experience in this arena will undoubtedly be a valued resource.

Responsibilities

As a Senior Investigator - Special Investigations Unit (SIU), Medicaid for Crestline Advisors, you will:

• Research and review records to identify potential areas of improper claims payment, which might indicate fraud, waste, and abuse (FWA).
• Use designated audit tracking tools and provide findings in an established analytic report format.
• Collaborate and communicate with the investigation departments of our vendors and other partners in the county, state, and federal government, as dictated by the scope of the project.

Qualifications

Need to have:

• One of the following:
• Bachelor's degree or higher in public administration, health care administration, or other field appropriate to the position and three or more years’ experience conducting healthcare fraud investigations.
• Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.
• Experience working with:
• Medicaid, Medicare, or other publicly funded health programs.
• A managed care organization.
• Microsoft Office Suite (Excel, Word, OneNote, Teams, Outlook), Google Sheets, etc.

Nice to have:

• Certified Coder with at least 5 years of experience in healthcare-related investigations or healthcare audits.
• Knowledge of state and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or Medicaid.
• Knowledge of claims processing activities, systems, and terminology.
• Excellent verbal and written communication skills.

EEO

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Additional Info

Other Information

• Hours may vary and are not guaranteed.
• This is a consultant position without benefits.
• Consultants are onboarded as 1099 and required to pay their own taxes.
• Consultants may need to provide their own equipment for project use – telephone and laptop.

References

Must be available upon request