Remote Associate Fraud & Abuse Investigator (CPC)

Sentara Health; Oklahoma City (OK); À distance; USD 44 000 - 63 000; Plein temps

Avantages offerts par ce poste

Adoption, Fertility and Surrogacy Reim

Long-Term Disability

Short-Term Disability

Life Insurance

Legal Resources Plan

Annual discretionary bonus

Résumé du poste

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. This full-time position requires a Bachelor's degree and 2+ years in medical coding or related healthcare or auditing fields. Certification as CFE or AHFI is preferred.

The role involves reviewing coding and reimbursement, triaging leads, and contributing to investigations into suspected fraud and abuse, with occasional travel to Virginia Beach.

Qualifications

• Bachelor's degree required.
• Minimum 2 years combined experience in Medical Coding or Healthcare or Audit or Compliance or Investigations.
• Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred.

Responsabilités

• Assist in the investigation of potential fraud, waste, and abuse.
• Conduct research in support of an investigation.
• Collect and evaluate potential suspicious patterns in claims data and enrollment data and refer to Investigator for investigation or settlement.
• Ensure accurate reimbursement and compliant coding practices.
• Participate in special projects as required.

Connaissances

Professional writing

Verbal communication

Time management

Complex problem solving

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Formation

Bachelor's degree

Description du poste

Sentara Health Plans is seeking an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. This full-time position requires a Bachelor's degree and 2+ years in medical coding or related healthcare or auditing fields. Certification as CFE or AHFI is preferred.

The role involves reviewing coding and reimbursement, triaging leads, and contributing to investigations into suspected fraud and abuse, with occasional travel to Virginia Beach.