Do you want to work for a company that Forbes named one of the Top 50 Most Innovative Companies? Are you looking to fast-track your career with one of LinkedIn's top companies in the U.S.? If so, keep reading!Title of Job: Remote Referral Analyst Location: REMOTE (anywhere in the US) CSI Companies is hiring a Remote Referral Analyst for our Fortune 100 healthcare client in Minnetonka, MN. This job can be worked from anywhere in the US as long as you have high speed internet and a distraction-free home office area. Job Summary The Remote Referral Analyst is primarily responsible for submitting tips, suspicions, and confirmed referrals of suspected Fraud, Waste, and Abuse (FWA) in compliance with state and federal regulations for all lines of business, including Medicaid, Medicare, and Commercial. This role ensures accuracy, compliance, and timely submission of referrals while maintaining strong communication with internal stakeholders. Pay : $30 - 34 an hour based on experience. Hours: Full Time - Monday-Friday 8am - 4:30pm CST Why this Opportunity?
- Top ranked company in Fortune's World's Most Admired Companies 14 years in a row .
- This healthcare client is ranked number one in key attributes of reputation:
- Innovation
- People management
- Social responsibility
- Quality of Management
- Financial soundness
- Long-term investment value
- Quality of products
- Services and global competitiveness
Status: Temp to Perm position. This position will go permanent with this Fortune 100 company, and upon hire they will be eligible for outstanding benefits, 3 weeks of PTO, extremely low full coverage medical coverage, and much more! When you convert, this could very likely be eligible for a pay increase as well. Effective Date / Tentative Start Date: Interviewing Immediately Job Duties:
- Analyze allegations of suspected fraud, validate financial impacts to the organization, and ensure referrals meet all necessary criteria prior to submission to regulatory agencies.
- Complete approximately 50-60 referrals monthly, ensuring accuracy and compliance with varying regulatory requirements and turnaround times across multiple lines of business.
- Gather and compile health-plan-specific documentation, including claims data, overpayment calculations, medical records, audit letters, coding summaries, and state-required forms
- Access multiple databases and shared drives to retrieve relevant information, ensuring adherence to minimum-necessary data standards
- Submit referrals within defined turnaround times, ensuring clear, concise, and compliant reporting in accordance with applicable state and federal regulations
- Redact non-essential information unrelated to the specific line of business being referred
- Serve as a subject matter expert (SME) for assigned states, encompassing knowledge of regulatory requirements, contractual agreements, customer expectations, and documentation processes for Commercial, Medicare, and Medicaid plans
- Communicate consistently with internal Special Investigations Units (SIUs) and other departments to identify and address gaps in reporting processes
- Provide recommendations for process improvement to enhance the accuracy and efficiency of referral reporting
Requirements
- Bachelor's degree in healthcare, business, or equivalent work experience required
- Strong understanding of fraud, waste, abuse and error within a healthcare setting
- Strong understanding of payment integrity end to end operations
- 1-2 years of medical and/or behavioral health investigative or compliance experience
- A reliable high-speed internet connection (the faster the better!)
- Ability to pass a background check and drug test
- Private, quiet, and distraction-free workspace in a room with a closed-door
Highly Preferred
- Large corporation experience
- Health plan / managed care / healthcare industry experience
- Previous experience working remotely
WHO SHOULD APPLY? If you have experience in Fraud, Waste, and Abuse (FWA), regulatory compliance, medical investigations, or Commercial, Medicare, and Medicaid plans, we would love for you to apply!Apply to become part of the team that is not only changing people's lives for the better but changing the health care system for the next generations to come. About Us The CSI Companies is a recruiting firm established in 1994 that has been awarded Best of Staffing for 8 years in a row. We provide outstanding services to the world's leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted. Benefits Offered:
- Weekly pay
- Medical, dental, and vision coverage
- Voluntary Life and AD&D coverage
- Paid Training
- Opportunity for advancement upon performance and availability
APPLY NOW and a recruiter will be in touch with you to schedule a phone screening! #LindsayUL