Remote Fraud & Abuse Investigator (CPC Certified)

Sentara Health; Pennsylvania; À distance; USD 44 000 - 63 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Tuition assistance

Annual bonus potential

Paid time off

Résumé du poste

Sentara Health Plan seeks an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time role. The position offers 8am–5pm EST, Mon–Fri, with travel to Virginia Beach once yearly.

Candidates must have a Bachelor's degree and CPC certification (or obtain within 12 months). Responsibilities include investigating suspected fraud or abuse across providers, reviewing coding and audits, and supporting claims-reimbursement processes.

Qualifications

• Bachelor's degree required or equivalent experience
• CPC certification required or within 12 months
• CFE or AHFI preferred

Responsabilités

• Contribute to in-depth investigations of suspected fraud or abuse across provider, pharmacy, employer, member, and broker interactions.
• Review coding across pharmacy, physician, hospital, and ancillary services in audits.
• Review reimbursement systems for claims processing and ensure adherence to policies.
• Triage and prioritize leads and referrals; assist in investigations.
• Conduct research and collect potential suspicious patterns in claims data and provider enrollment data.
• Maintain comprehensive case files and participate in special projects as required.

Connaissances

Professional Writing

Verbal Communication

Time Management

Critical Thinking

Excel

Word

Access

Outlook

Formation

Bachelor's Degree

Experience in Medical Coding or Healthcare Audits

Description du poste

Sentara Health Plan seeks an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time role. The position offers 8am–5pm EST, Mon–Fri, with travel to Virginia Beach once yearly.

Candidates must have a Bachelor's degree and CPC certification (or obtain within 12 months). Responsibilities include investigating suspected fraud or abuse across providers, reviewing coding and audits, and supporting claims-reimbursement processes.