Heard About the New Medicare Rx Benefit?

Heard About the New Medicare Rx Benefit?

Delmarva Foundation has been awarded a contract related to this new benefit and we need talented staff for a variety of assignments in our Easton office. The positions afford you the opportunity to build your expertise in this important new benefit and fill an important role in protecting the rights of Medicare beneficiaries. We seek candidates for the following positions:

Claims Analyst/Review Nurse - This position provides the opportunity to interact with Medicare beneficiaries who call to report on experiences that may represent potential fraud in the delivery of this Medicare benefit. Successful candidates must possess knowledge of healthcare, an RN diploma and at least 3 years of clinical experience. Other requirements include:
• Strong communication skills & basic computer knowledge, including familiarity with Microsoft programs.
• Ability to manage multiple tasks including desk audits and claims review.
• Ability to work independently as well as in a team environment.

Data/Health Analyst - Working with Medicare claims data, this position involves study design, data analysis, and report preparation. Data analysis is performed using SAS programming and other analytic software - SAS proficiency is essential. Other requirements include:
• Strong analytical skills with experience analyzing large claims data sets and a biostatistics background.
• BS/BA in Statistics, Biostatistics, Epidemiology, Public Health, Economics or related discipline.
• Team player with strong oral and written communications skills who is creative, innovative and committed to the process of continuous quality improvement.

Fraud Investigator - The Fraud Investigator performs in-depth evaluation of potential Medicare Prescription Drug fraud cases and develops complex cases that involve high dollar amounts, sensitive issues, or that otherwise meet criteria for referral to OIG and prepares these cases for referral to OIG. Utilizing leads provided by the team and referrals from government and private agencies works with the team to prioritize complaints for investigation and then investigates , conducts interviews and reviews information to make potential fraud determinations. Investigations utilize a variety of sources including internal guidelines, Medicare provider manuals, Medicare regulations, and the Social Security Act. Position requires:
• 5 years of experience in fraud investigation/detection or a related field that demonstrates expertise in reviewing, analyzing, and developing information and making appropriate decisions.
• Prior successful experience with OIB/FBI or similar agencies preferred.

The Delmarva Foundation is a highly successful and rapidly growing not-for-profit company with a passion for excellence and over 25 years of experience in health care. We offer you:
• Excellent company paid benefits, including parking;
• Flexible weekday hours with holidays off;
• Interesting and challenging work;
• A stimulating work environment; and
• The chance to join a team in making a positive difference.

For more information, visit us at www.dfmc.org. For immediate consideration, please submit resume and salary requirements to: Attn: MEDIC Positions, Delmarva Foundation for Medical Care, 9240 Centreville Road, Easton, Maryland 21601. Fax: (410) 822-5032. E-mail: [Click here for email]. Affirming equal opportunity in principle and practice, Delmarva is an equal opportunity employer, committed to developing a diverse workforce.

Source - Daily Times - Salisbury, MD
REQUIREMENTS
Please refer to the Job Description to view the requirements for this job