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JOB DESCRIPTION
Job Summary
The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers in order to achieve and maintain appropriate anti-fraud oversight.
Job Duties
JOB QUALIFICATIONS
Required Education
Bachelors degree or Associates Degree, in criminal justice or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
PREFERRED EXPERIENCE:
At least 5 years of experience in FWA or related work.
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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Job Identification: 2026098
Job Category: Legal, Risk, & Compliance
Posting Date: 2024-05-09T15:45:41 00:00
Job Schedule: Full time
Full Time
Insurance
$58k-75k (estimate)
06/08/2024
08/07/2024
molinahealthcare.com
ALBUQUERQUE, NM
7,500 - 15,000
1980
Public
MARIO MOLINA
$10B - $50B
Insurance
Molina is a managed care organization providing health care to individuals and families in 13 states & Puerto Rico via Medicaid & Medicare programs.