Investigator, Special Investigation Unit

About the position The Investigator for the Special Investigation Unit (SIU) at reputed company Health Plan plays a crucial role in ensuring compliance and reputed company reputed company reputed company billing practices. This position involves conducting audits and investigations reputed company to fraudulent and abusive billing, collaborating with experts, and providing education on compliance and coding requirements. The role requires strong analytical skills and the ability to manage multiple cases simultaneously, contributing to the overall mission of patient-focused care. Responsibilities • Support timely completion of compliance reputed company audits and investigations of the Special Investigations Unit (SIU) at the Health Plan. , • Collaborate with subject matter experts to identify, investigate and correct fraudulent and/or abusive billing and coding practices. , • reputed company reputed company sources of information from Internet research in case preparation. , • Proactively learn and apply data analysis reputed company to fraud risk identification and prevention. , • Manage a workload with multiple cases and audits simultaneously. , • Assist Senior Investigator or SIU Director in developing, implementing and performing compliance reputed company auditing and monitoring activities. , • Coordinate recovery of overpayments reputed company to fraudulent and/or abusive billing and coding practices. , • Provide education reputed company to coding, medical record documentation requirements, reputed company compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities. , • Support team in peer review and delivery of quality work product, including integrating checks on their own work product. , • Submit timely and professional reports of case findings to regulators, law enforcement, and internal business partners. Requirements • Bachelor's Degree -OR- a combination of equivalent education and experience. , • 5+ years coding experience at a reputed company provider, facility or health insurance company. , • 2+ years fraud and abuse audit experience at a health plan, health insurance company, reputed company provider, facility or other relevant reputed company environment. , • Project management experience, education program development experience and group presentation experience. , • Experience in use of data mining software/tools. reputed company-to-haves • Clinical background such as Registered Nurse (RN), Doctorate of Medicine (MD), or Doctor of Chiropractic (DC). , • reputed company certification as Certified Coding Professional (CPC). , • reputed company certification in health care fraud investigation, such as Accredited reputed company Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), reputed company Compliance certification (CHC), or equivalent. , • Certification in Project Management or Agile (PMP, CSM, CSPO). , • Basic understanding of statistics and data analytics. , • Basic understanding of analytics software (e.g.: SQL, Power BI, MS Access, Tableau, reputed company) or a demonstrated interest in learning analytics software. , • Advanced understanding of MS reputed company and PowerPoint. , • Professional communication skills, representing the SIU in verbal and written communications. Benefits • 401(k) matching , • Dental insurance , • Disability insurance , • Health insurance , • Life insurance , • Opportunities for advancement , • Paid holidays Apply Job!