Healthcare Fraud Investigator Resume
The transaction that takes places in the healthcare industry in terms of money each year is gigantic. No wonder deception, fraud, and siphoning off money are the frequent occurrence witnessed by the industry. The immoral acts are committed by physicians, surgeons, medical facilities, Medicare beneficiaies, and those in hunt of easy money. To rein such practices, healthcare fraud investigator are employed by insurance companies, federal agencies, and organizations that provide Medicaid Investigations services.
Candidates applying for a healthcare faud investigator position must essentially be a licensed registered nurse (RN). A degree in criminal justice, heathcare administration, social work, professional counseling, and business administration is also acceptable with minimum three years of experience. The job aspirant must also possess communication, computer, analytical, and critical thinking skills.
Healthcare Fraud Investigator Resume Example
Ricky Thomas
16, Lakeside Street
Cleveland, OH 57712
Telephone Number: 599 - 040 - xxxx
Email Id: rickythomas@example.com
Career Objective:
With a towering attitude for public service infused with requisite knowledge and experience, I want to work for an organization as a healthcare fraud investigator and conduct healthcare fraud, discrepancies in billing and service provided, and abuse investigations.
Summary of Skills:
- Excellent knowledge of the terms and regulations of Medicare/Medicaid
- Ability to check, arrange, and evaluate extensive and complex medical records
- Skilled in reviewing and planning case strategies and identifying heathcare fraud schemes
- Strong communication, computer, and analytical skills
- Excellent time management and organizational skills
- Comfortable with irregular hours and working on weekends and in night shifts
- Valid driver's license and readiness to travel extensively
- Highly professional, cultured, patient, and matured person
Work Experience:
Healthcare Fraud Investigator
Masons Hospital, Cleveland, OH
June 2012 - Present
- Evaluate and investigate fraud,abuse complaints, and billing discrepancies
- Answer complaints received through emails and phone calls
- Review medical records and claim data and plan case management
- Gather substantial evidence to prove fraud, waste, and mismanagement
- Document each phase of investigation using tracking tool and system
- Develop case summaries and provide copies each to defendant and complainant
- Perform audit for private and public healthcare organizations
- Coordinate with internal and external resources to collect facts
- Develop, implement, and monitor correction actions to streamline processes
Registered Nurse
ABC Hospital, Cleveland, OH
January 2010 - May 2012
- Recorded patients' system and explained treatment and medicine
- Performed diagnostic tests and provided reports for physician's assessment
- Analyzed medical records and data and planned treatment
- Prioritized patients' needs and ensure the staff provide them
- Triaged patients and monitored proper medical care is provided to them
- Evaluated emergency situations and provided required nursing interventions
- Hold training session of patients, relatives, and the staff
- Provided supportive and restorative therapy as required
- Coordinated and integrated nursing care in the facility
Education: -
Bachelor's Degree in Nursing
ABC University, Cleveland, OH
2008
-
Certified Fraud Examiner
ACFE, Cleveland, OH
2009
Reference: -
Steve Williams
Chief Fraud Investigator
Masons Hospital, Cleveland
Telephone Number: 588 - 040 - xxxx
Email Id: stevewilliams@example.com
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