Remote Fraud & Abuse Investigator (CFE/CPC)

Sentara Health; Georgia; Teletrabalho; USD 44 000 - 63 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Adoption, Fertility and Surrogacy Reim

Disability & Critical Illness Plans

Life Insurance

Legal Resources Plan

Potential annual discretionary bonus

Resumo da oferta

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position is full-time and permanent, with a 40-hour work week and travel to Virginia Beach once per year.

The role involves contributing to in-depth investigations for suspected fraud or abuse across provider, pharmacy, employer, member, and broker interactions, and reviewing coding in desk and on-site audits.

Qualificações

• Bachelor's Degree required; minimum 2 years combined experience in Medical Coding, Healthcare, Internal/External Audit, Regulatory/Compliance, Claims Investigations or Criminal Investigation/White Collar Crime.
• CFE or AHFI certification required or preferred.
• Strong writing, verbal communication, time management and MS Office skills.

Responsabilidades

• Assist in investigation of potential fraud, waste and abuse.
• Conduct research to support investigations.
• Collect and evaluate suspicious patterns in claims data and provider data.
• Ensure accurate reimbursement and compliant coding.
• Participate in special projects as required.

Conhecimentos

Professional Writing

Verbal Communication

Time Management

Critical Thinking

Excel

Word

Access

Outlook

Formação académica

Bachelor's Degree

Certified Fraud Examiner (CFE)

Accredited Health Care Fraud Investigator (AHFI)

Descrição da oferta de emprego

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position is full-time and permanent, with a 40-hour work week and travel to Virginia Beach once per year.

The role involves contributing to in-depth investigations for suspected fraud or abuse across provider, pharmacy, employer, member, and broker interactions, and reviewing coding in desk and on-site audits.