Located in Charlestown, MA, the Commonwealth Medicine Center for Health Care Financing (CHCF) helps state agencies, our primary clients, identify opportunities to increase savings and reimbursements through federal and other third party sources, establish effective savings and reimbursement programs and capitalize on all possible revenue streams. At the same time, we identify opportunities for our clients to increase health care related services and reduce the net cost of delivery.
Through an Interagency Service Agreement between the Massachusetts Executive Office of Health & Human Services (EOHHS) and the University of Massachusetts Medical School, the Provider Compliance Unit (PCU) ensures program integrity by performing fraud, waste, abuse, and program compliance activities as required to preserve federal financial participation (FFP) and comply with federal and state regulations. Core activities of this unit include compliance with the Surveillance Utilization Review Subsystem (SURS), development and running of algorithms and conducting desk and onsite reviews (audits).
The PCU seeks a Fraud Investigator II conducts investigations involving extensive research to identify industry trends and patterns which target aberrant billing practices. The Fraud Investigator II collaborates with the Associate Director on more complex case reviews as needed, in addition to performing activities related to data mining, data analysis and recoveries. With increasing independence, the Fraud Investigator II is assigned to multiple provider types and serves as a senior investigator in the Unit. The Fraud Investigator II will coach other investigators on developing techniques to find provider schemes based on federal and state regulations that govern Medicaid.
Why join Commonwealth Medicine’s Provider Compliance Unit? If you join PCU you will be joining an elite group of professionals who strive to identify outliers and/or anomalies in data through statistical analysis and data mining. Come join a team who are subject matter experts in the domain identifying fraud, waste and abuse.
CWM offers a rewarding environment where cutting edge and pioneering health care and clinical services programs and projects are developed and managed.
If you are a high-energy, driven individual who loves a challenge and thrives in a fast-paced entrepreneurial environment, you are encouraged to submit your credentials for further consideration.
This position is in the Schrafft's Building, located in Charlestown, Massachusetts, just north of Boston and easily accessible by public transportation.