Senior Healthcare Fraud Investigator

CVS Health; Texas; Sur place; USD 47 000 - 102 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Bonus eligibility

Résumé du poste

CVS Health is seeking a Senior Investigator to conduct high-level investigations of healthcare fraud and abuse. You will handle sensitive cases, including Medicaid-related matters, and work with cross-functional teams to build compelling cases.

You will document activities, perform data mining to identify aberrant billing, and provide guidance to junior investigators. Travel up to 10% may be required; a background in coding and strong Excel skills are essential.

Qualifications

• 3+ years investigative experience in healthcare fraud and abuse.
• Working knowledge of medical coding; CPT, HCPCS, ICD-10
• Experience with Microsoft Office with advanced Pivot Tables in Excel.
• Ability to travel up to 10% (approx. 2-3x per year).

Responsabilités

• Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business.
• Researches and prepares cases for clinical and legal review.
• Documents all appropriate case activity in case tracking system.
• Facilitates feedback with providers related to clinical findings.
• Initiates proactive data mining to identify aberrant billing patterns.
• Makes referrals, both internal and external, in the required timeframe.
• Facilitates the recovery of company and customer money lost as a result of fraud matters.
• Provides on the job training to new Investigators and provides guidance for less experienced Investigators.

Connaissances

Healthcare fraud investigations

CPT/HCPCS/ICD-10 coding

Excel pivot tables

Travel up to 10%

Formation

Bachelor's degree in health care or related field

Description du poste

CVS Health is seeking a Senior Investigator to conduct high-level investigations of healthcare fraud and abuse. You will handle sensitive cases, including Medicaid-related matters, and work with cross-functional teams to build compelling cases.

You will document activities, perform data mining to identify aberrant billing, and provide guidance to junior investigators. Travel up to 10% may be required; a background in coding and strong Excel skills are essential.