Adecco is seeking a highly motivated and detail-oriented **Referral Analyst** for a **6-month Remote** contract position with a leading healthcare organization. The ideal candidate will have a strong understanding of fraud, waste, and abuse within the healthcare industry and experience conducting investigations and ensuring compliance with state and federal regulations. **Top reasons to work with Adecco.** + Payday every Friday + Upskilling opportunities through the Adecco Aspire Academy + An opportunity to get hired on permanent with our client. + Assigned your very own onboarding specialist. **Job Details** + **Length of assignment:** 6 Month Assignment + **Location:** Remote + **Pay: $31.00 - $42.81** per hour + **Shift/Hours:** Monday – Friday 8 AM – 4:30 PM This is a fully **Remote** position. **Requirements** + Bachelors in healthcare or business or the equivalent + 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 and compliance experience + Intermediate to advance skills in using Microsoft tools. **Job description** + The Referral Analyst is responsible for submitting tips, suspicion, and confirmation referrals of suspected Fraud, Abuse, or Waste according to state and federal regulations for all lines of business, including Medicaid, Medicare, and Commercial. + Analysts complete approximately 50 - 60 Referrals a month. + Each referral may include multiple lines of business, varying turnaround times, and regulatory requirements. + Analysts must analyze the request; validate the allegation of suspected fraud and financial impact to UHC, prior to submitting a referral to a regulatory agency. + In some instances, analysts are required to provide supporting documentation (i.e. claims data, overpayment calculations, medical records, audit letters, coding summary, state required form). + Analysts access multiple databases and shared drives to collect this health-plan specific documentation to ensure the referral is complete and includes minimum-necessary information only. + Analyst are required to report all referrals within each defined turnaround time, in a clear, concise, and compliant manner. + Analysts are required to redact any information that is not for the line of business that is being referred. + Analysts are aligned by state and are expected to be subject matter experts (SMEs) in their states for all lines of business in that state. + As a state SME, the analyst is expected to understand the current regulatory requirements, contractual agreements, customer expectations, internal databases to access/validate supporting documentation, and turnaround times for their assigned states, for Commercial, Medicare, and Medicaid plans. + Analysts are expected to communicate with internal SIU departments and UHC customers on a consistent basis to identify and remedy gaps in reporting referrals. **Pay Details:** $31.00 to $42.81 per hour Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adecco.com/en-us/candidate-privacy The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: + The California Fair Chance Act + Los Angeles City Fair Chance Ordinance + Los Angeles County Fair Chance Ordinance for Employers + San Francisco Fair Chance Ordinance