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Form of workHennepin Health (HH) is seeking a Senior Investigator to lead Special Investigation Unit (SIU) functions. The Senior Investigator will be responsible for managing a comprehensive program to combat suspected fraud, waste or abuse (FWA) and leading FWA investigations from triage to conclusion.
Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500referral bonus. For more information visit employee referral program.
Location and hours:
This position is hybrid and will be performed both on-site at the Hennepin County Health Services Building, 525 Portland Avenue, Minneapolis, MN 55415, and remote as job duties require. Work hours will be Monday through Friday, with typical hours of 8 a.m. to 4:30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New employees who are hired into remote or hybrid positions between January 2, 2022 to December 31, 2024, will receive $500 toward the cost of establishing consistent internet connectivity, payable upon completion of 6 months of employment.
About the position type:
This is a full-time, benefit-earning position.
This position is internally classified as an Administrative Assistant, Senior.This is a full-time, benefit-earning position.
Click here to view the job classification specification.
In this position, you will:
- Research and identify potential areas of fraud, waste, and abuse (FWA).
- Identify and request data to facilitate investigations, including the creation and utilization or analytic reports.
- Manage investigations from identification and triage until completion.
- Make recommendations on final disposition of cases.
- Work with other departments of Hennepin Health to effectuate case dispositions (e.g. implement payment suspensions, make policy updates, provider outreach, etc.).
- Work with the investigation areas of our vendors.
- Work with our partners in the county, state, and federal government.
- Create regular reports for Hennepin Health's Board and regulators.
- Act as the subject matter expert on areas related to FWA.
- Manage existing policy and procedure documents related to FWA investigations.
- One of the following:
- Eight or more years of experience in *general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.
- Bachelor's degree or higher in public administration, business administration, public health, criminal justice, health care administration or other field appropriate to the position and four or more years of experience in *general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.
Nice to have:
- Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.
- Experience with:
- Medicaid, MinnesotaCare, Medicare, or other publicly funded health programs.
- Healthcare fraud investigations.
- Claims or claims processing with knowledge of medical terminology, costs, and enrollment.
- Working with or for a managed care organization.
- Knowledge of:
- State and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or Medicaid.
- Microsoft Office Suite (Excel, Word, OneNote, Teams, Outlook), Google Sheets, and industry claims platforms (e.g. Facets).
- Ability to:
- Request, use, and analyze data to perform investigations.
- Have excellent verbal and written communication skills.
About the department:
Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well-being of our members and the community.
About Hennepin County:
Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align to one or more of our overarching goals -- that Hennepin County residents are healthy, protected and safe, self-reliant, assured due process, and mobile.
Our employees receive a combination of generous benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (log in as Guest).
Hennepin County envisions an organization where our commitment to diversity and the reduction of disparities is fundamental in providing excellent service to our community.
Your future. Made here.
This posting may be used to fill current and future vacancies.
This position will have access to systems or other documentation that contains HIPAA data.
Invitations to interview will be based upon an assessment of education and experience. Final candidates may be required to complete a background check.
If you have any questions, please contact:
Taylor Dahlberg
Taylor.Dahlberg@hennepin.us
Employment Type: Full-time
