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Posted: Saturday, February 3, 2018 5:29 PM

Company:Hawaii Medical Service Assn.Job Title:Data Analyst (Fraud & Abuse)Exempt or Non-Exempt:ExemptIsland:OahuCity:HonoluluLocation:HonoluluEmployment Type:Full TimeJob Summary:Protects corporate assets through the detection of complex analysis and practices authorized or unauthorized, which cause unjustifiable expenditures and to pro-actively identify areas vulnerable to fraud and abuse. Work closely with law enforcement investigators to resolve these issues. Track and report department activities to internal departments and ensure compliance with government requirements.Duties and Responsibilities:Responsible to independently research and evaluate department reports for all lines of business to pro-actively identify areas vulnerable to fraud and abuse. Analyze any aberration to verify whether the variance is due to fraudulent business related practices. Create summary report for investigators.Coordinate information and meet with law enforcement and other external investigative staff to monitor, audit, or provide oversight for HMSA s anti-fraud, waste and abuse program. Provide case briefings, prepare duly requested or subpoenaed materials, and assist in any concurrent or subsequent investigation and case development activities (e.g. for prosecution or case expansion).Prepare written reports as required for the various government plans and programs administered by HMSA, including Akamai Advantage, Federal Plan 87, FEP program and QUEST. Provide status update to the department management on an ongoing basis regarding pending investigations, cases with significantly large financial impact and cases with law enforcement involvement.Collect and maintain historical data to track patterns and detect trends over a specific period of time. Track department activities and information including hotline call logs, case investigations, and clinical reviews. Use data to document and to report internal and/or government compliance requirements as needed.Effectively access the HMSA on-line information system, government websites and national on-line databases, provider information network (PINS), fraud information data base (FIDS), and other various software programs to collect and retain historical data to maintain a current listing of sanctioned providers. Post information for various internal departments for their use. Assist with PS credentialing to identify sanctioned providers.Learn new software and become proficient with available in-house systems to install edit parameters. Initiate claim flags for providers who are under review to detect and extract fraud and abuse data on a claim by claim basis.Maintain controls for sensitive files, records, storage and back-up support. Track and ensure delivery of the medical records that are sent to the off-site Medical Directors. Work with investigators and admin services to ensure that files are not lost, and is delivered and returned in a timely and secure manner.Perform other duties as assigned.Minimum Qualifications:Bachelor s degree and two years of related work experience; or equivalent combination of education and experience.Good analysis, critical thinking and problem solving skills.Good working knowledge of Microsoft Office applications.
EEO/AA/Disability/Vets Employer
Associated topics: attorney, company, compliance department, internal, lawyer, legal, legal affairs, legal department, llp, market

Source: http://www.jobs2careers.com/click.php?id=4730364405.96


• Location: Honolulu (Oahu)

• Post ID: 9939127 honolulu
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