Healthcare Compliance Specialist

Job Locations US-VA-Tysons
Posted Date 3 months ago(5/29/2020 11:15 AM)
Job ID
# of Openings


LMI is a government consulting firm dedicated to advancing the management of government. We operate free of political and commercial bias, and we gauge our success by the mission outcomes we enable our government clients to achieve. Our clients value our objectivity, deep government IQ, and expertise in logistics, analytics, information technology, and management consulting. We seek talented, hardworking people who share our passion for public service and want to join us in solving the most pressing challenges in government management



LMI is looking for a Healthcare Compliance Specialist (Fraud, Waste, Abuse), who applies expertise in problem-solving to developing solutions to operational, strategic, and data challenges for federal public health agencies. Work will be primarily conducted at LMI headquarters in McLean, VA, with occassional travel to client site (Baltimore, MD).

  • Assists in leading the development and maintenance of corporate healthcare FWA capabilities and offerings
  • Participate in the detection, investigation and ongoing monitoring of member and/or provider FWA through random audits, data analysis, medical record review and onsite and desk audits
  • Proactively apply knowledge of current FWA schemes and medical policies to identify areas of risk for FWA
  • Identify and provide process improvements that reduce workload or improve quality for Federal health programs
  • Interpret, analyze and present key findings to clients
  • Advance quantitative and/or qualitative analysis via new techniques to identify areas of FWA
  • Develop relationships with clients and identify future opportunities
  • Conduct training and mentoring to new staff, peers and/or other FWA professionals
  • Prepares clear and concise verbal and written communications in layman’s terms when interpreting report findings


Minimum Qualifications

·        Bachelors degree in Economics, Finance, Statistics, Mathematics, Computer Science, Management Information Systems, Engineering, Business Analytics disciplines, or related area

·        Accredited Healthcare Fraud Investigator (AHFI) preferred

·        Knowledge of the Medicare and Medicaid programs

·        Minimum 2 yrs. in healthcare FWA and/or consulting  

·        Strong communication skills, both written and oral

·        Ability to work independently and manage multiple projects and responsibilities in a fast-paced environment

·        Knowledge of any of the following areas: policy analysis, program evaluation, program integrity, informatics, strategic planning and process improvement

Desired Skills and Background

·        Experience working in Payment Integrity / FWA detection and prevention space

·        Healthcare claims adjudication experience

·        Other certifications: Certified Coding Specialist (CCS), Certified Fraud Specialist (CFS), and Certified Fraud Examiner (CFE)

·        Prior experience in a law enforcement environment, such as OIG, FBI, etc.

·        Experience payer special investigation unit


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LMI is an Equal Opportunity Employer. LMI is committed to the fair treatment of all and to our policy of providing applicants and employees with equal employment opportunities. LMI recruits, hires, trains, and promotes people without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity, age, national origin, disability, veteran status, or any other factors protected by applicable law.

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