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Sr. SIU Investigator

Company: Lumeris
Location: Saint Louis
Posted on: August 18, 2019

Job Description:

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, youll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris. Position: Sr. SIU Investigator Position Summary: The Senior Investigator, FWA Analytics will be responsible for effectively leading the day-to-day work of data analysis to assist and conduct investigations by conducting data analysis of alleged Fraud, Waste and Abuse by providers, members, and others. This work will include initiating, analyzing, and developing data for the SIU team for leads for cases, creating data for the SIU Universes, quarterly dashboards, CMS reports, and other data analysis as needed. The Senior Investigator, FWA Analytics must show strong time management skills, the ability to work on multiple projects at one time, work effectively both individually and within a team, and the ability to lead others. Job Description: Role and Responsibilities: - Assist in hiring, training, development, mentoring and counseling of investigators - Participate in evaluation of vendor selection and contract oversight - Develop and provide training to internal staff as appropriate to facilitate the awareness of healthcare fraud, waste, and abuse - Collaborate with SIU Investigators on cases and other issues - Participate in client workshops and provide presentations on fraud, waste, and abuse activities - Participate in Fraud, Waste, and Abuse detection and prevention - Create Fraud, Waste, and Abuse dashboards and universes - Conduct review of quarterly drug trend, pharmacy and provider outlier comparison reports - Identify, suggest, and work to create process improvements - Ensure timely reporting of findings and trends - Attend appropriate education workshops to stay informed on data trends within industry - Report instance of fraud to law enforcement and other agencies Experience, Qualifications and Education: - Bachelors degree in Mathematics, Business, Health Information Administration, Statistics or related field - At least 4 years of related experience, including 2 years of professional insurance experience in a Special Investigations Unit (SIU) - Knowledge of Medicare - Knowledgeable about applicable fraud statutes, CMS guidelines, Federal and State requirements - Demonstrated leadership skills - Strong analytical, planning and organizational skills - Strong verbal and written communication skills - Computer proficiency in Microsoft Word, Excel, Power Point and Outlook - Comprehensive knowledge of SIU practices - Strong presentation skills, ability to identify training needs, develop and present formalized training programs - Ability to travel overnight approximately 10% of the time Lumeris is an EEO/AA employer M/F/V/D. Location: St. Louis, MO Time Type: Full time

Keywords: Lumeris, St. Louis , Sr. SIU Investigator, Accounting, Auditing , Saint Louis, Missouri

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