Remote Fraud & Abuse Investigator, CPC/CFE

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

Benefits offered by this job

Medical, Dental, Vision

Life Insurance

Paid Time Off

Job summary

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role with annual travel to Virginia Beach.

The candidate will contribute to in-depth investigations across provider, pharmacy, and claims data while ensuring compliant coding and reimbursement practices. Requires Bachelor's degree and 2+ years in medical coding or related healthcare and eligible fraud credentials.

Qualifications

• Bachelor's Degree
• Minimum of 2 years combined experience in Medical Coding OR Healthcare OR Internal/External Audit OR Regulatory/Compliance OR Claims Investigations OR Criminal Investigation/White Collar Crime
• Certified Fraud Examiner (CFE) OR Accredited Health Care Fraud Investigator (AHFI)
• Professional Writing, Verbal Communication, Time Management, Complex Problem Solving/Critical Thinking, Microsoft Excel and Word, Microsoft Access and Outlook

Responsibilities

• 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, provider enrollment data, and other sources and refers to Investigator for investigation or settlement.
• Assures accurate reimbursement is obtained and coding practices are compliant.
• Participates in special projects as required.

Job description

Sentara Health Plans is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote role with annual travel to Virginia Beach.

The candidate will contribute to in-depth investigations across provider, pharmacy, and claims data while ensuring compliant coding and reimbursement practices. Requires Bachelor's degree and 2+ years in medical coding or related healthcare and eligible fraud credentials.