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Fraud Specialist

Tampa, FL

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The Fraud Specialist assists with the development, implementation, maintenance of and adherence to the organizations policies and procedures covering auditing performed trips of patients, as well as addressing fraud waste and abuse matters as they arise.

Location: Tampa, FL 33626 (must be able to report to facility as needed)

Pay: $15/hr

Onsite Training Schedule: Monday - Friday from 8:00 AM to 4:30 PM for the first 3-4 weeks

Work from Home Schedule: Monday - Friday 10:00 AM to 6:30 PM (Equipment provided)

Essential Duties and?Responsibilities

  • Identify, implement, and maintain audit?policies?and procedures with management.
  • Conduct?internal oversight, risk assessments, and monitoring of audit results.
  • Conduct or assist in compliance investigations, including fraud, waste, and abuse matters.
  • Support?the development of auditing training materials.
  • Support the development and modification of tracking systems for investigations.
  • Initiate, facilitate and promote activities to foster informational audit awareness to management.
  • Provide various support services within the billing and claims department.
  • Ability to effectively communicate and resent to all levels of management.
  • Manage daily inbound/outbound telephone calls to?facilitate explanation of?audit?results.
  • Always maintain confidentiality whether in?reference?to confidential?information or?as it relates to medical information for specific patients.
  • Communicate effectively and?professionally?with external customers, including phone verification of visits with medical providers.
  • Meet daily productivity quotas on a?consistent?basis.

Minimum Qualifications

  • High School diploma or GED
  • Previous fraud experience - required
  • Previous experience in healthcare - preferred
  • Minimum of one year Customer service or call center experience - required
  • Minimum of one year data entry experience - required
  • Proficient in Microsoft Office Software
  • Must type 30 WPM
  • Must operate 10-Key Calculator by touch
  • Must have oral, written, and interpersonal communication skills
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