Healthcare Fraud Investigator - Pensacola, United States - Cambio Consulting Group

Description

Job Description

Cambio Consulting Group LLC is seeking to hire a full-time Healthcare Fraud Investigator with a minimum of 4 years of experience supporting the United States Attorney's Office (USAO), U.S. Department of Justice. The position will be focused on supporting the district in criminal and civil investigations of health care matters. The investigator will handle cases independently, as lead agent, or as a team member with cases involving sensitive matters or prominent individuals, organizations, or corporations and may also involve obscure leads, uncooperative witnesses, and conflicting evidence.

This position requires handling matters in any of the three divisions within the USAO Northern District of Florida (NDFL) in Tallahassee, Pensacola, and Gainesville FL. Some statewide travel may also be required. On occasion, travel may include attendance training at the National Advocacy Center located in Columbia, South Carolina. When travel is required, it will generally entail review of records, witness interviews, or court attendance. Local travel (within the local commuting area of the USAO – 50 miles).

Working hours of Monday – Friday, 8:00AM to 5:00 PM.

Please be prepared to provide three (3) professional references.

Duties:

· Plan and conduct investigations of a complex and difficult nature; perform quantitative, qualitative, or other analysis of relevant facts; and prepare the results to support the mission of the USAO. Investigations may be conducted solely by the USAO, or more typically, in conjunction with federal and state agencies responsible for programs supported by federal funding. These agencies may include, but are not limited to, the United States Department of Health and Human Services; the Federal Bureau of Investigation; the Defense Criminal Investigative Service; and the Drug Enforcement Administration.

· Research background information using various databases and sources; identifying subjects to investigate and developing leads; conducting interviews; collecting and processing evidence; preparing reports, charts, and exhibits; and helping build financial investigations regarding the subjects and their conduct. To that end, the investigator would utilize analytical skills in order to do the following: identify and obtain financial records; identify and obtain health care provider data; analyze health care, business, and financial records; and conduct interviews of witnesses and prepare reports of interviews.

· Develop an understanding of all applicable federal, state, or local law to the extent necessary to make sound decisions on the direction and scope of investigations. Determine proof required to affix responsibility for violations, and develop methods for obtaining, preserving, and presenting evidence effectively.

· Work with the assigned Assistant United States Attorneys (AUSAs), Paralegal Specialists and supervisory attorneys to determine applicable statutory and regulatory law and identify possible violations.

· Perform a variety of ancillary services in direct support of assigned cases and matters.

o Use electronic databases to identify assets, documents, and other physical evidence.

o Prepare interim and final reports on progress of investigations for use by AUSAs and supervisory attorneys. Reports shall include significant findings and conclusions, recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, and other aspects of case.

o Arrange for secure storage, preservation, organization, and indexing of voluminous documentary evidence.

o Assist in compilation and analysis of documents and physical evidence, and creation of charts, graphs, videotapes, and other audio-visual materials for use in hearings and at trial. Assist in developing the most efficient method for conducting investigations and identify any resources that may be needed.

· Initiate contacts with federal, state, and local officials, and other organizations and individuals related to subject of investigation for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives. Examine books, ledgers, payroll records, cost reports, billing statements, invoices, correspondence, computer data and other records pertaining to the transactions, events, or allegations under investigation. Establish and verify relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary to successful case resolution.

Requirements & Key Skills

· MUST have a bachelor's degree and a minimum of 4 years of related work experience.

· Minimum of four years' experience in planning and conducting civil or criminal complex investigations concerning misuse of public, private, or insurance funds.

· Law enforcement experience; Knowledge of legal and law enforcement terms and procedures.

· Knowledge, skills, and abilities to perform the duties as specified herein.

· Working knowledge of current investigative techniques including the use of commercial databases and other sources of information.

· Experience in analyzing, organizing, and presenting a large volume of data through the use of common software programs (e.g. Excel).

· Experience in reviewing and understanding medical records and knowledge of medical billing procedures.

· Skill in using word processing, spreadsheet software, and Microsoft Office software programs.

· Excellent written and oral communication skills.

· Experience in interviewing potential witnesses.

· MUST have a valid driver's license.

· Active Public Trust Clearance or ability to obtain clearance through a minimum of a seven- or ten-year background investigation.

Cambio's Public Sector Practice helps executives and managers at all levels of government maximize performance and efficiency in the face of ever tightening budgets and increased demand for services. Our public sector team members find solutions that help government leaders with issues including policy review, governance, analytics, financial management, human capital, and information technology for a broad range of federal agencies.