JOB ANNOUNCEMENT
Position: Senior Medicare Patrol (SMP Case Intake Analyst
California Health Advocates (CHA)
Location: Telecommute
Job Summary:
California Health Advocates is looking for a Full Time Case Intake Analyst (CIA).
Under the direction of the Deputy Director/SMP Program Manager, the ideal candidate must have great communications skills and professional on the phone. Candidate must have at least
1 year of progressively responsible administrative experience and proficient in MS Office applications.
The CIA plays a crucial role in investigating and analyzing Medicare fraud cases. They are responsible for identifying fraudulent activities within the Medicare program. The SMP CIA is an experienced professional who possesses extensive knowledge of Medicare regulations, healthcare billing practices, and fraud detection techniques.
Primary Responsibilities as Case Intake Analyst
1. Fraud Detection and Investigation:
- Analyze Medicare fraud information claims and identify patterns, trends, and anomalies indicative of potential fraud or abuse.
- Conduct in-depth investigations into suspicious activities, including reviewing medical records, billing documents, and other relevant documentation.
- Interview claimants, beneficiaries, and healthcare providers to obtain additional information and testimonies related to potential fraud cases.
- Collaborate with the Administration for Community Living (ACL) and the Office of
Inspector General (OIG), or the Centers for Medicare & Medicaid Services (CMS) for fraud claim evaluation and review. If ACL proceeds with an investigation, they will gather evidence, interview relevant parties, and analyze documentation to assess the validity of the reported fraud. This may involve working in collaboration with other agencies, such as law enforcement or regulatory bodies, depending on the nature and scope of the fraud.
2. Data Analysis and Reporting:
- Generate comprehensive reports detailing investigation findings, including evidence, recommendations, and potential legal actions.
- Present findings and recommendations to federal agencies, law enforcement agencies, and other relevant parties.
- Enter all Case Intake Information into the federal database.
- Keep track of all records of potential fraud claims as well as a log of all claims handled on a weekly basis.
3. Collaboration:
- Collaborate with internal team to develop and implement fraud prevention strategies.
- Stay updated on current fraud schemes, healthcare regulations, and emerging trends in Medicare fraud.
- Assist in preparing documentation for semi-annual report and annual report.
Qualifications / Experience:
- At least three years of progressively responsible administrative experience.
- Ability to manage multiple tasks.
- Proficiency in ‘Microsoft Office’ database and spreadsheet software applications.
- Ability to work independently with minimal supervision and carry out assignments to completion with minimum instructions.
- Ability to work in a team environment and routinely keep in communication with staff, volunteers, SMP partners and CHA members located throughout California related to Senior Medicare Patrol.
- Knowledge of Medicare Billing, Medi-Cal, Long-Term Services and Supports and health care fraud issues is a plus.
Compensation / Hours:
Full Time (40hrs per week)
Starting Hourly Rate- $35-38/hr per hour (DOE)
Health/Dental insurance/ Holiday/Vacation, SIMPLE IRA
- (This position is contingent on availability of funding.)
Contact:
Catherina Isidro, Executive Director
California Health Advocates
5380 Elvas Avenue, Suite 221
Sacramento, California 95819
cisidro@cahealthadvocates.org
Christina Dimas-Kahn, Deputy Director
California Health Advocates
5380 Elvas Avenue, Suite 221
Sacramento, California 95819
cdimaskahn@cahealthadvocates.org
DO NOT APPLY DIRECTLY THROUGH CONTACT EMAIL. PLEASE APPLY VIA INDEED
Job Type: Full-time
Pay: $72,800.00 - $79,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
Travel requirement:
- No travel
Experience:
- Microsoft Office: 3 years (Preferred)
Work Location: Remote
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