Sentara Healthcare
Associate Fraud and Abuse Investigator
This job is now closed
Job Description
- Req#: JR-92935
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $37.26 per hour
- Opportunity for career advancement and growth within the organization
- Work remotely with candidates in multiple states
- Comprehensive benefits package including medical, dental, vision, and tuition assistance
- Supportive and family-friendly work culture that encourages community involvement
- Potential for annual discretionary bonuses based on eligibility criteria
What to Expect (Job Responsibilities):
- Conduct in-depth investigations for suspected fraud or abuse concerning provider, pharmacy, and member interactions
- Review coding quality through routine desk audits and occasional on-site audits
- Assess reimbursement systems for health insurance claims processing and adherence to policies
- Collect and evaluate suspicious patterns in claims data and other sources for investigation
- Maintain comprehensive case files and participate in special projects as required
What is Required (Qualifications):
- Bachelor's Degree required or a minimum of 2 years combined experience in Medical Coding, Healthcare, Internal/External Audit, Regulatory/Compliance, Claims Investigations, or Criminal Investigation
- Certified Professional Coder (CPC) required or to be achieved within 12 months of hire
- Strong professional writing and verbal communication skills
- Proficiency in Microsoft Excel, Word, Access, and Outlook
- Excellent time management and complex problem-solving abilities
How to Stand Out (Preferred Qualifications):
- Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred
- Experience in healthcare fraud, waste, and abuse investigations
- Familiarity with healthcare compliance regulations
- Knowledge of claims processing and reimbursement systems
- Previous experience in a healthcare-related role
#HealthcareServices #FraudInvestigation #RemoteWork #CareerGrowth #CompetitiveBenefitsAbout the company
Sentara Healthcare is a not-for-profit healthcare organization serving Virginia and northeastern North Carolina.
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