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ABOUT EDS:  EDS, an HP company, is a leading global technology services provider, delivering business solutions to its customers. EDS founded the information technology outsourcing industry more than 46 years ago. Today, as an HP business group, EDS delivers one of the industry's broadest portfolios of information technology and business process outsourcing services to customers in the manufacturing, financial services, healthcare, communications, energy, transportation, and consumer and retail industries, and to governments around the world.

WHY EDS: We differentiate ourselves in the IT marketplace by providing outstanding service, innovation and industry thought leadership. To monitor our progress and encourage candid collaboration with our clients, we established the Service Excellence program. It is instrumental to our success in cultivating and maintaining long-term business relationships.

Job Description:

This position is for the Eastern Benefit Integrity Support Center (BISC) Contract. The mission of this contract is to detect and deter fraud and abuse in the Medicare Program for Part A and B New York and New Jersey

This position is to support Medicare Systems in a Nurse Investigator/Reviewer role. The responsibilities of this role are to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, over payment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support..

Job Essential Functions:

* Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
* Ability to research regulations and cite violations.
* Ability to conduct self-directed research to uncover problems in Medicare payments made to institutional and non- institutional providers.
* Ability to make claim payment decisions based on clinical knowledge.
* Ability to compose correspondence, reports and referral summary letters.
* Ability to communicate effectively, internally and externally
* Ability to handle confidential material.
* Ability to report work activity on a timely basis.
* Ability to work independently and as a member of a team to deliver high quality work
* Ability to attend meetings, training, and conferences, overnight travel required

Position Prerequisites:

* Degree needed: Registered Nurse (RN)
* Minimum of three to five years experience in the medical field as a registered nurse.
* Current nursing license - RN
* Strong investigative skills
* Strong communication and organization skills
* Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases preferred
* Strong PC knowledge and skills

**TO APPLY FOR THIS POSITION**

1. Go to the following link: http://www.edscareers.com  
2. Select and click on link “Search for Jobs”
3. Enter requisition number 2448780 the “Keywords” field
4. Apply for the position

Thank you for your interest!

*This position is not one for which the employer will sponsor an individual for employment visa status or pay relocation assistance.

EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. EDS, an HP company, is an equal opportunity employer and values the diversity of its people. Copyright 2008 Hewlett-Packard Development Company, LP.