Senior Investigator - Special Investigations Unit (SIU)

Hennepin Health is seeking a Senior Investigator for the Special Investigations Unit (SIU). This Senior Investigator will be responsible for managing a comprehensive program to combat suspected fraud, waste, and abuse (FWA) and leading FWA investigations from triage to conclusion. Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit employee referral program. Find us here at upcoming career fairs! Location and hours: This position is hybrid and will be performed both on-site at the Health Services Building at 525 Portland Avenue, Minneapolis, MN 55415 (this location is accessible by public transportation and light rail) and remote as job duties require. Work hours will be Monday through Friday, 8 a.m. - 4:30 p.m. with Wednesday and Thursday being onsite. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New Employee Orientation (NEO) for all new benefit-earning employees is in-person in downtown Minneapolis. Details about NEO will be provided upon hire. About the position type: This is a full-time, benefit-earning position. This position is internally classified as an Administrative Assistant, Senior. Click here to view the job classification specification. In this position, you will:

• Lead research and identify potential areas of fraud, waste, and abuse (FWA) and request data to facilitate investigations, including the creation and utilization of analytic reports.
• Manage investigations from identification and triage until completion, making recommendations on final disposition of cases.
• Work with other department of Hennepin Health to effectuate case dispositions (e.g., implement payment suspensions, make policy updates, provider outreach, etc.).
• Collaborate with the investigation departments of our vendors, and other partners in the county, state, and federal government.
• Create regular reports for Hennepin Health’s Board and regulators.
• Perform as the subject matter expert on areas related to FWA.
• Manage existing policy and procedure documents related to FWA investigations.

Need to have:

• One of the following:
• Bachelor's degree or higher in public administration, business administration, criminal justice, health care administration, or other field appropriate to the position and four or more years of experience in general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.
• Eight years or more of general administrative work related to the management of departmental/organizational operations or in a specialty area appropriate to the position.

Nice to have:

• Certified Fraud Examiner (CFE) credential or Accredited Health Care Fraud Investigator (AHFI) designation.
• Experience working with:
• Medicaid, MinnesotaCare, Medicare, or other publicly funded health programs.
• Healthcare fraud investigations.
• Claims or claims processing, including knowledge of medical terminology, costs, enrollment, and group data.
• A managed care organization.
• Microsoft Office Suite (Excel, Word, OneNote, Teams, Outlook), Google Sheets, and industry claims platforms (e.g. Facets).
• Knowledge of state and federal laws and regulations pertaining to health insurance and/or government programs, including Medicare and/or Medicaid.
• Ability to:
• Request, use, and analyze data to perform investigations.
• Have excellent verbal and written communication skills.

About the department: Hennepin Health provides health care coverage to Hennepin County residents who are enrolled in a Minnesota Health Care Program. Hennepin Health is a nonprofit, state-certified health maintenance organization that contracts with the Minnesota Department of Human Services. We envision being a leader in partnering with our members and communities to improve health, by integrating health care and service to enhance the health and well-being of our members and the community. About Hennepin County: Hennepin is the largest county government organization in Minnesota. Our employees work every day to improve the health, safety and quality of life for our residents and communities. All of our jobs align with our mission to serve residents through transformative services that eliminate disparities, eliminate inequities, and create opportunity for all and our vision of a community where all people are healthy, all people are valued, and all people thrive. Our employees receive a combination of competitive benefits and positive workplace culture not found at other organizations. This includes meaningful work that impacts our community, competitive pay, work-life balance, a variety of benefits and opportunities to grow. Learn more at The Bridge (login as Guest). Hennepin County envisions an organization where our commitment to diversity and the elimination of disparities is fundamental in providing excellent service to our community. Your future. Made here. This posting may be used to fill current and future vacancies. Watch this video for application best practices and tips. This position will have access to systems or other documentation that contains HIPAA data. Invitations to interview will be based upon an assessment of education and experience. Final candidates may be required to complete a background check. If you have any questions, please contact: Kristin Checco [email protected] Apply tot his job Apply To this Job