Team Lead - Investigations (Full-time, Remote)

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📅  Posted 13 days ago 📍 United States
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Job Description

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel!

In this role, the Team Lead will be responsible for the general oversight and performance of No Surprises Act investigative staff as well as a point of contact for the client. The Team Lead works independently, as well as collaboratively with the junior investigators.


Job Responsibilities:

1.     Maintains strict confidentiality and security of the personal health information contained in the data sources.


2.     Processes and manages complaints and other information indicating a potential violation of provider requirements using TeamMate+ audit software.


3.     Requests and reviews providers’ documents to determine compliance with the relevant requirements.


4.     Drafts complaint summary and findings report to be delivered to the client.


5.     Organizes and participates in virtual meetings and consultations with providers for discussions related to the review of provider documents, the performance of the investigation, and related findings.


6.     Conducts regular process improvement evaluations utilizing Lean principles.


7.     Organizes and helps facilitate entrance and exit conference meetings with providers, the client, and other designated CMS staff.


8.     Develops and maintains collaborative relationships across teams to proactively support engagement initiatives and content campaigns across multiple groups and channels.


9.     Interfaces with CMS to manage case progression, highlighting issues, clarify or raise questions to drive understanding and rationale for case recommendations and outcomes. 


10.  Provide process and training content development; assist with process development improvement, identify job aid and template needs.


11.  Mentor investigators to develop case management skills and improve performance.


12.  Proactively coordinate with investigators to understand recurring CMS or policy team feedback.


13.  Monitor patterns on case analysis, knowledge gaps or timeliness concerns by completing daily case reviews for investigations work prior to policy review.


14.  Manages day-to-day operational aspects of project and the affiliated scope:

a.     Reviews deliverables and milestones prepared by team,

b.     Provides forecast information to support financial analysis, and

c.     Captures and tracks program metrics and perform analysis.

d.     Report status, milestones and constraints to appropriate Management staff.


15.  Clarifies, identifies, and tracks requirements and issues, removes barriers, resolves minor project issues and communicates to senior management when required. Escalates issues to appropriate Management staff


16.  Remains informed regarding industry changes, trends, best practices and applicable regulations and assesses impact of changes on the project.


17.  Exercises appropriate discretion and judgment relating to company policies and practices in an effective, consistent and professional manner.


18.  Adheres to applicable policies and procedures ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information. 


19.  Performs ad hoc tasks/duties as assigned.


20.  Exercises appropriate discretion and independent judgment relating to company policies and practices in an effective, consistent and professional manner.


21.  Adheres to applicable policies and procedures ensuring commitment to quality, compliance and security to protect the confidentiality, integrity, and availability of sensitive data and information. 


Supervisory Responsibilities:

1.              Provides management direction and guidance.

2.              May supervise on site and/or remote staff.

3.              Complete performance reviews.

4.              Conduct goal setting with staff.


1.     Minimum of a Bachelor’s Degree in public policy, public health, health administration, business, or in another relevant field

2.     Minimum of three (3) years post education work experience in investigations in a corporate, agency, or professional environment or identifying noncompliance activities in a healthcare setting

3.     Skilled in MS Office 2016 software or higher version: Word, Excel, PowerPoint and Outlook.

4.     Experience with provider coding, billing practices, other provider administrative functions, including knowledge or experience with air ambulance services

5.     Professional certification as a Certified Fraud Examiner (CFE), in compliance or related field, such as AAPC’s Certified Professional Compliance Officer (CPCO) or American Academy of Professional Coders’ (AAPC), is preferred

6.     Possess a working knowledge of compliance laws, regulations, and healthcare industry practices

7.     Possess a working knowledge of health insurance cost sharing requirements for Medicare, Medicaid, and private insurance and/or ability to quickly learn complex information and apply the information to conducting investigations

8.     Detail-oriented

9.     Strong writing and project management skills

10.  Must be a flexible and proactive team player


Additional Requirements:

Must pass post hire background screening checks.