Regulatory Compliance Analyst - Baltimore, United States - Lumen Solutions Group Inc.

Description

Company Description
Lumen Solutions Group Inc. is a technology consulting Services Company based in Virginia.

We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.

We specialize in strategy development, portfolio management and enterprise architecture.


Job Title:
Regulatory Compliance Analyst


Location:
Baltimore, Maryland-hybrid


Duration:
Long term Contract


Job Description:

The role of the Special Investigations Unit (SIU) Investigator is to assist in the reduction and recuperation of losses through the detection, investigation, and resolution of low to medium levels fraud, waste, and abuse schemes, resulting in the savings and recovery of funds.

Independently conduct low to medium level investigations and provide support as part of an assigned team to all levels (low to medium) investigations of suspected fraud, waste, and abuse.

In conjunction with assigned team or management, develop and execute investigative plans that may include performance of audits of financial business records, provider and subscriber medical data, claims, systems' reports, medical records, analysis of contract documents, provider/subscriber claims history, benefits, external data banks and other documents to determine the possible existence of fraud and/or abuse.

Preferred Qualifications

Credential in a health care or investigations related area such as Certified Fraud Examiner (CFE), Accredited Health Fraud Investigator (AHFI), RN/LPN, or Certified Professional Coder (CPC).

Knowledge of ICD 10 and CPT Codes, medical terminology, extensive training in claims and subscriber customer service methods, and previous experience in the health care industry.

Knowledge, Skills and Abilities (KSAs):

Proficiency Knowledge of laws that pertain to public and insurance funds - Proficient Excellent communication skills both written and verbal.

- Proficient Ability to recognize, analyze, and solve a variety of problems. - Proficient Ability to maintain effective interpersonal relationships.

Additional information
Interview format: 1st – Phone Screen, 2nd – MS Teams Video Interview

Please send resume to:
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