SIU Healthcare Investigator
New
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Integrity Management Services, Inc.Healthcare
Alexandria, Virginia, United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field
- Required Skills
- Microsoft Excel
Requirements
- Bachelor's degree in Criminal Justice or a related field, OR at least 3 years of insurance claims investigation or law enforcement experience
- Minimum of 2 years of experience in healthcare claims analysis, auditing, payment integrity, or a related field
- Knowledge of applicable fraud statutes and regulations
- Knowledge of federal guidelines on recoupments and other anti-FWA activity
- Experience handling confidential information
- Strong analytical and problem-solving skills
- Proficiency in Microsoft Office, particularly Excel
- Familiarity with claims processing or audit software
- Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML and Fraud Professional (CAFP), or Certified Professional Coder (CPC) desired
Responsibilities
- Identify and conduct investigations into known or suspected FWA with high autonomy
- Develop documentation to substantiate findings, including formal reports, graphs, audit logs, and other supporting documentation
- Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings
- Participate in the development and presentation of FWA-related education for assigned Customers
- Perform coding reviews for flagged claims, to support Coding team
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