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Job Description
- Req#: 1016
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work in a mission-driven environment focused on improving healthcare delivery
- Supportive and collaborative work culture
- Chance to make a positive impact on the integrity of healthcare services
- Engage in meaningful work that contributes to underserved communities
What to Expect (Job Responsibilities):
- Perform medical record and claims reviews for Medicare, Medicaid, and other claims data
- Identify potential overpayment, fraud, waste, and abuse in healthcare claims
- Conduct desk reviews or field audits to meet contract requirements
- Collaborate with benefit integrity investigation experts and pharmacists for case evaluations
- Provide case summaries and support the investigative process with data entry and reporting
What is Required (Qualifications):
- Minimum Bachelor's Degree required
- 2 - 4 years of relevant work experience required; 5 - 7 years preferred
- Current, active, and non-restricted RN licensure required
- Exceptional analytical and problem-solving skills
- Strong attention to detail and organizational abilities
How to Stand Out (Preferred Qualifications):
- Coding certification preferred
- Experience in healthcare fraud prevention or investigation
- Familiarity with Medicare and Medicaid regulations
- Background in auditing or compliance within the healthcare sector
#HealthcareServices #FraudPrevention #CareerOpportunity #ImpactfulWork #HealthcareCompliance
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