Remote Associate Fraud & Abuse Investigator (CPC)

Sentara Health; New Hampshire; Teletrabalho; USD 44 000 - 63 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Annual discretionary bonus eligibility

Comprehensive benefits package

Resumo da oferta

Sentara Health Plan is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work. This is a full-time, 40-hour-per-week role with occasional travel to Virginia Beach (1x/year).

The role involves contributing to in-depth investigations of suspected fraud or abuse across providers, pharmacies, employers, members, and brokers, and reviewing coding quality in audits to ensure compliant reimbursement.

Qualificações

• Bachelor's degree required with strong writing and communication skills.
• Minimum of 2 years combined experience in Medical Coding, Healthcare, or related audits.
• Certifications: CFE or AHFI preferred.

Responsabilidades

• Assist in investigations of potential fraud, waste and abuse.
• Conduct research to support investigations and identify suspicious patterns.
• Collect and evaluate data from claims, enrollment, and other sources for referrals.
• Ensure accurate reimbursement and coding compliance.
• Participate in special projects as required.

Conhecimentos

Professional writing

Verbal communication

Time management

Complex problem solving

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Formação académica

Bachelor's Degree

Descrição da oferta de emprego

Sentara Health Plan is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work. This is a full-time, 40-hour-per-week role with occasional travel to Virginia Beach (1x/year).

The role involves contributing to in-depth investigations of suspected fraud or abuse across providers, pharmacies, employers, members, and brokers, and reviewing coding quality in audits to ensure compliant reimbursement.