2 Investigator - Special Investigation Unit Jobs in Beaverton, OR
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Investigator - Special Investigation Unit
$68k-97k (estimate)
Full Time
3 Days Ago
Switch4 LLC is Hiring an Investigator - Special Investigation Unit Near Beaverton, OR
Role: Investigator - Special Investigation Unit
Location: Beaverton, OR
Type: FTE/Permanent
Job Description
Location: Beaverton, OR
Type: FTE/Permanent
Job Description
- Support timely completion of compliance related audits and investigations of the Special Investigations Unit (SIU).
- Collaborate with and learn from subject matter experts to identify, investigate and correct fraudulent and/or abusive billing and coding practices, which may advance in complexity with experience
- Leverage credible sources of information from Internet research in case preparation
- Proactively learns and applies data analysis related to fraud risk identification and prevention
- Able to manage a workload with multiple cases and audits simultaneously
- May assist Senior Investigator or SIU Director in developing, implementing and performing compliance related auditing and monitoring activities.
- Coordinate recovery of overpayments related to fraudulent and/or abusive billing and coding practices; keeps organized audit work papers that enables collaboration with external teams in the audit and recovery process
- Coordinate with parties with compliance accountabilities to facilitate corrective action completion and behavior change
- Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to staff, vendors and contracted providers/facilities
- Support team in peer review and delivery of quality work product, including integrating checks on their own work product
- Presents on fraud risk in a professional manner, in written and oral reports, tailored to providers, executives, members, and regulators
- Submit timely and professional reports of case findings to regulators, law enforcement, and internal business partners
- Provide training on fraud prevention to executives, caregivers, business partners, and members
- Supports timely processing of risk report intake triage, timely processing of prepay audit claims, and other compliance requirements
- Bachelor's Degree -OR- a combination of equivalent education and experience
- 5 years coding experience at a healthcare provider, facility or health insurance company
- 2 years fraud and abuse audit experience at a health plan, health insurance company, healthcare provider, facility or other relevant healthcare environment
- Project management experience, education program development experience and group presentation experience
- Experience in use of data mining software/tools
- Clinical background such as Registered Nurse (RN), Doctorate of Medicine (MD), or Doctor of Chiropractic (DC)
- Current certification as Certified Coding Professional (CPC)
- Current certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), Healthcare Compliance certification (CHC), or equivalent
- Certification in Project Management or Agile (PMP, CSM, CSPO)
- Basic understanding of statistics and data analytics
- Basic understanding of analytics software (e.g.: SQL, Power BI, MS Access, Tableau, Alteryx) or a demonstrated interest in learning analytics software
- Advanced understanding of MS Excel and PowerPoint
- Professional communication skills, representing the SIU in verbal and written communications with executives, law enforcement, regulators, attorneys, physicians, members, etc.
Job Summary
JOB TYPE
Full Time
SALARY
$68k-97k (estimate)
POST DATE
07/03/2024
EXPIRATION DATE
07/30/2024
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