Remote Fraud & Abuse Investigator (CPC)

Sentara Health; Maine; Remote; USD 44,000 - 63,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Holidays

Tuition Assistance

Job summary

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position is full-time with standard hours and travel to Virginia Beach once a year.

Remote eligibility includes ME and many other states; occasional on-site travel to Virginia Beach is required. The role involves investigations of fraud, coding reviews, and ensuring compliant reimbursement, with a strong emphasis on documentation and data analysis.

Qualifications

• Bachelor's degree required.
• 2+ years combined experience in medical coding, healthcare, audits, compliance, or investigations required.

Responsibilities

• Contribute to in-depth investigations of suspected fraud or abuse across provider, pharmacy, employer, member, and broker interactions.
• Review coding quality in routine desk audits and on-site audits.
• Assess reimbursement systems and ensure policy compliance.
• Triages leads and assists in investigations of potential fraud, waste, or abuse.
• Maintain comprehensive case files and participate in special projects.

Skills

Professional Writing

Verbal Communication

Time Management

Critical Thinking

Excel

Word

Access

Outlook

Education

Bachelor's Degree

2+ years combined experience in Medical Coding/Healthcare/Audit/Compliance/Investigations

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Job description

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role. The position is full-time with standard hours and travel to Virginia Beach once a year.

Remote eligibility includes ME and many other states; occasional on-site travel to Virginia Beach is required. The role involves investigations of fraud, coding reviews, and ensuring compliant reimbursement, with a strong emphasis on documentation and data analysis.