Remote Fraud & Abuse Investigator (CPC Preferred)

Sentara Hospitals; United States; Remote; USD 73,000 - 110,000; Full time

Job summary

Sentara Health Plans is seeking a Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work in the United States. This full-time role involves investigating suspected fraud, reviewing coding accuracy, and supporting claims processing across Sentara’s product lines.

Travel to Virginia Beach is required once yearly. Candidates should have a Bachelor's degree (preferred) and 2+ years in audit, compliance, or healthcare with CPC preferred or obtainable within 12 months of hire.

Qualifications

• Bachelor's degree preferred.
• Experience reviewing claims, analyzing data, identifying potential billing irregularities.
• Familiarity with healthcare claims, provider billing patterns, FWA concepts.

Responsibilities

• Identify, investigate, analyze, and evaluate instances of potential fraud, waste, and abuse.
• Conduct interviews or correspond with patients, providers, witnesses, or other relevant parties to determine settlement, denial, or review.
• Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
• Learn and conduct statistical sampling of complex medical claims.
• Assists in drafting settlements.

Skills

Fraud detection

Data analysis

Education

Bachelor's degree

Tools

Certified Professional Coder

Job description

Sentara Health Plans is seeking a Fraud and Abuse Investigator/Certified Professional Coder (CPC) for remote work in the United States. This full-time role involves investigating suspected fraud, reviewing coding accuracy, and supporting claims processing across Sentara’s product lines.

Travel to Virginia Beach is required once yearly. Candidates should have a Bachelor's degree (preferred) and 2+ years in audit, compliance, or healthcare with CPC preferred or obtainable within 12 months of hire.