Analyst

• Identify and investigate healthcare billing activities leading to improper payments.
• Review claims data and conduct analysis to look for patterns of potential FWA and other improper payments.
• Utilize information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels.
• Conduct data analysis to review claim and case history.
• Review claims history, medical reviews, provider files, etc. and utilize data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
• Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets.

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