What are the responsibilities and job description for the Clinical Integrity Officer position at Amerihealth Caritas?
Job Description
AmeriHealth Caritas is seeking a skilled Investigative Healthcare Specialist to join our team. As a vital member of our organization, you will play a critical role in identifying and preventing fraud, waste, and abuse across our healthcare network.
Key Responsibilities
• Lead complex investigations into potential healthcare fraud and abuse
• Conduct thorough analyses to detect fraudulent activity and ensure compliance with regulatory standards
• Collaborate with law enforcement agencies, regulatory bodies, and internal teams to uphold organizational integrity
Requirements
• Associate's degree required (Bachelor's preferred)
• Minimum 3-5 years of experience conducting healthcare fraud investigations and collaborating with state, federal, and local law enforcement agencies
• Strong knowledge of Medicaid, Medicare, and fraud-related regulatory statutes required
• Proficiency in Microsoft Excel for data analysis and investigative documentation
Benefits
We offer a comprehensive benefits package, including flexible work arrangements, competitive pay, paid time off, health insurance coverage, and tuition reimbursement.
