Lifecare believes our employees are an integral part of our company success. Lifecare’s standard package of benefits includes a competitive salary, medical, dental and vision insurance, ten paid holidays as well as paid vacation and sick days. Lifecare also provides a 401(k) retirement plan and life and disability insurance.
We are currently looking for Healthcare subject matter experts including medical claims/case reviewers and investigators to support medical review and fraud detection and investigations for medical insurance, workers compensation, long term disability initiatives across commercial, Federal and state programs.
Healthcare Medical Reviewers
Description – Conducts clinical reviews of medical records during the course of Healthcare claim/case reviews and fraud investigations… Apply healthcare coverage guidelines and reimbursement rules in making clinical determinations as to the medical necessity and appropriateness of services rendered and billed and corresponding payment determinations.
Requirements – Bachelor’s degree in healthcare or related field preferred or equivalent combination of education and experience. Active license as a Registered Nurse (RN). Medical review and/or utilization/quality assurance review and ICD-9-CM/CPT coding experience. Knowledge of medical terminology and experience in the analysis and processing of medical insurance, worker compensation and/or long term disability rules and regulations preferred.
Healthcare Fraud Investigators
Description – Conducts independent investigations of potential Healthcare, Workers Compensation or long term disability fraud or abuse. Reviews healthcare claims and case data to identify aberrancies in billing and utilization practices. Develops leads received from complaints and other sources. Prepares case findings and recommendations to the client.
Requirements – Experience in healthcare fraud detection and investigations in the areas of medical insurance, worker compensation and/or long term disability. College degree in related field preferred. Prior law enforcement investigative experience desirable.
Healthcare Data Analysts
Description – Utilize data analysis techniques to detect aberrancies in Healthcare utilization data. Perform evaluations and analysis of potential fraud cases and requests for information using claims information and other sources of information.
Requirements – Two years experience in data analysis as well as demonstrated knowledge of Healthcare claims and case processing and payment methodologies, or a combination of education and equivalent work experience. Knowledge of medical insurance, worker compensation and/or long term disability rules and regulations preferred.