Remote Fraud & Coding Investigator (CPC)

sentara; United States; Remote; USD 44,000 - 63,000; Full time

Job summary

Sentara Health Plan is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time position. The role involves in-depth investigations of suspected fraud or abuse across various stakeholders and audits of coding and claims processing.

Candidates must have a Bachelor's degree and CPC certification (or be on track to obtain it within 12 months). Travel to Virginia Beach is required once a year.

Qualifications

• Bachelor's Degree REQUIRED
• Minimum 2 years combined experience in Medical Coding or Healthcare
• Certified Professional Coder (CPC) REQUIRED (or achieved within 12 months)
• CFE or AHFI preferred

Responsibilities

• Contribute to in-depth investigations for suspected fraud or abuse across provider, pharmacy, employer, member, and broker interactions
• Review the quality of coding in routine desk audits and occasional on-site audits
• Review reimbursement systems relating to health insurance claims processing and ensure adherence to policies
• Triage and prioritize leads and member complaints; review referrals; assist investigations
• Conduct research to support investigations and evaluate suspicious patterns in claims data
• Ensure accurate reimbursement and compliant coding; maintain comprehensive case files
• Participate in special projects as required

Skills

Professional Writing

Verbal Communication

Time Management

Critical Thinking

Microsoft Excel

Microsoft Word

Microsoft Access

Outlook

Education

Bachelor's Degree

Tools

CPC

Job description

Sentara Health Plan is hiring an Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) for a remote, full-time position. The role involves in-depth investigations of suspected fraud or abuse across various stakeholders and audits of coding and claims processing.

Candidates must have a Bachelor's degree and CPC certification (or be on track to obtain it within 12 months). Travel to Virginia Beach is required once a year.