Program Integrity Fraud Investigator

Sandhills Center   Greensboro, NC   Full-time     Health Care Provider
Posted on September 18, 2022
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Program Integrity Fraud Investigator

Sandhills Center is a Local Management Entity-Managed Care Organization (LME-MCO) serving people in eleven counties in central North Carolina. We have a robust network of providers who offer treatment and support for mental health, intellectual/developmental disabilities and substance use disorders.

•The position will review claims, medical records and billing data along with other relevant documentation from all types of providers who submit claims to Sandhills Center.
•To identify and provide detailed reports of areas of incorrect coding, missing or insufficient documentation, suspected Medicaid fraud/waste/abuse, and over utilization by providers and recipients.
•Most work will be undertaken out in the field, travel is required

Minimum Qualifications:
•Bachelor's degree in compliance, analytics, government/public administration, auditing, security management, or pre-law, or human services
•And have at least three (3) years of relevant experience
•Must reside in North Carolina
•Prefer One year experience in the analysis of mental health services in physical and pharmacy services.

Sandhills Center offers an Excellent Benefits package, including Local Government Retirement and 401k. Sandhills Center is a drug-free workplace; drug testing is required.