Remote Associate Fraud & Abuse Investigator (CPC)

Sentara Health; Athens (GA); Remote; USD 44,000 - 63,000; Full time

Benefits offered by this job

Discretionary bonus

Comprehensive benefits package

Adoption, Fertility and Surrogacy Reim

Disability plans

Life Insurance

Legal Resources Plan

Job summary

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role with occasional travel to Virginia Beach. The position is full-time, 40 hours per week, with remote work available for eligible US states.

Responsibilities include conducting investigations into fraud and abuse, auditing coding quality, and reviewing reimbursement processes, with opportunities for professional growth in a large healthcare organization.

Qualifications

• Bachelor's degree required.
• Minimum 2 years combined experience in Medical Coding, Healthcare, or related fields.
• Certification: CFE or AHFI preferred.

Responsibilities

• Contribute to in-depth investigations for suspected fraud or abuse.
• Review coding quality in routine desk audits and occasional on-site audits.
• Review reimbursement systems and ensure adherence to policies.
• Triage and prioritize leads and member complaints from internal sources.
• Assist in investigation of potential fraud, waste, and abuse.
• Collect and evaluate suspicious patterns in claims data and provider data.
• Ensure accurate reimbursement and compliant coding.
• Participate in special projects as required.

Skills

Professional Writing

Verbal Communication

Time Management

Complex Problem Solving

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Education

Bachelor's Degree

CFE

AHFI

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Job description

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role with occasional travel to Virginia Beach. The position is full-time, 40 hours per week, with remote work available for eligible US states.

Responsibilities include conducting investigations into fraud and abuse, auditing coding quality, and reviewing reimbursement processes, with opportunities for professional growth in a large healthcare organization.