Fraud, Waste and Abuse Analyst

Elite Technical is seeking a Fraud, Waste and Abuse Analyst to join our clients Utilization Management Department. This position discovers, develops, and implements analytics related to fraud, waste and abuse activities. The analyst will collaborate with business partners for the purpose of identifying and delivering robust reporting and analytics capabilities to drive improved business performance in the fraud, waste and abuse space. Primary Accountabilities:

- Assist in identifying, validating and recovering claim overpayments.
- Validate claims to ensure the accuracy of algorithms and that no refund has previously been posted.
- Identify new overpayment opportunities through review and research.
- Interpret and analyze data to accurately assess and demonstrate key insights into trends and opportunities.
- Research potential new ideas and follow algorithm development process.
- Provide feedback regarding inventory levels, algorithm effectiveness, and new ideas and assist with Quality Review process.
- Handle personal and confidential information with a high degree of integrity.

This position is a permanent/direct hire opportunity with our client, a Federal Health Plan in the BWI/Maryland area. This position is a hybrid opportunity once training has completed.

Required Skills

- Associates degree in accounting, business, healthcare or a related field. Equivalent work experience in a similar position may be substituted for educational requirement.
- 3+ years as a Fraud, Waste and Abuse Analyst
- QNXT & Fraud Shield strongly preferred, CPT and ICD10 coding a must.
- Excellent computer skills to include Microsoft Excel, HealthCare FraudShield software suite, QNXT claims adjudication system, savvy internet research skills and Ad hoc query and reporting.
- Highly organized, motivated self-starter with strong analytical and problem solving skills Excellent written and oral communication skills.
- Knowledge of medical terminology, CPT and ICD10 coding, analytical methodologies, and insurance and claim operations.

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Hybrid/Glen Burnie, MD



Anticipated Start Date

Monday, July 29, 2024

Job Type

Direct Hire

Anticipated Duration

Date Posted

Monday, July 8, 2024

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Elite Technical Services, Inc. participates in the E-Verify program to confirm the employment eligibility of all persons hired. This means that we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Elite Technical Services, Inc. will not use E-Verify to pre-screen job applicants.

Elite Technical Services, Inc. is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.