Healthcare Fraud Investigator Resume

[First Name] [Last Name]

Contact Address: [street] [Country] [City] [State/Province] [Zip Code]

Contact Number: (012)-345-6789

Email Address: [[email protected]]

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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: [email protected]
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