Healthcare Claims Case Manager at Minnetonka

The Case Manager is primarily responsible for triaging claims, and performing prospective and retrospective investigations to identify and resolve possible instances of healthcare fraud, waste and abuse.
 

Responsibilities include but are not limited to:
 Performing investigations.
 Reviewing medical records and claims.
 Writing Investigative Summary Reports.
 Participating in projects and program initiatives.
 Meeting established task turn-around-times (TATs). 
 Performing other duties as assigned.

We are seeking candidates with the following qualifications:
 BA/BS in Criminal Justice or Healthcare related field; experience may substitute for an undergraduate degree.
 Experience working in fraud investigations, preferably healthcare fraud.
 Law enforcement investigation experience with DOJ, OIG, FBI or other federal or state agency.
 Experience with government healthcare programs preferred (Medicare, Medicaid).
 AHFI Certification through NHCAA preferred.
 Certified Coding Specialist (i.e., CPC, CCA, CCS) preferred.
 Certified Fraud Examiner (CFE) preferred.
 Experience within the insurance claims industry preferred.
 Self-motivated, goal oriented, and has the ability to work independently.
 Strong verbal and written communication, time management, problem solving, organizational, and analytical skills required.
 Must be proficient in MS Outlook, MS Excel and MS Word.

Physical Requirements:
 Typing
 Using a mouse
 Extended periods of sitting at a computer, up to 8 hours each day
 Exerting up to 10 pounds of force occasionally
 Occasional scanning, copying and faxing
 Occasional filing of papers and occasional bending

Country: USA, State: Minnesota, City: Minnetonka, Company: Emdeon.