Medicaid/Medicare Program Integrity Analyst II

The Medicaid/Medicare Program Integrity Analyst II performs evaluation and development of leads, complaints, and/or investigations to determine if further investigation and administrative actions are warranted. Conducts independent reviews resulting from the discovery of situations that potentially involve fraud or abuse. Utilizes basic data analysis techniques to detect aberrancies in Medicare and Medicaid claims data, and proactively seeks out and develops leads/investigations received from a variety of sources, reviewing information contained in standard claims processing system files to detect potential fraudulent or abusive billing practices. Compiles and maintains documentation related to investigations,cases and leads.