What are the responsibilities and job description for the Senior Investigator position at VirtualVocations?
A company is looking for a Senior Investigator to conduct audits and investigations into healthcare claims.Key ResponsibilitiesConduct detailed audits and investigations into potential fraud, waste, and abuse within healthcare claimsReview medical records, verify charges, and generate audit reportsCollaborate with clients to deliver audit results and support case buildingRequired QualificationsExpertise in Audit Management, Quality Assurance, and Corporate Integrity AgreementsExperience with Medical Necessity Review, Proper Coding / Documentation, and ReportingAbility to work with healthcare personnel while demonstrating ethical behavior and maintaining confidentialityBachelor's degree in a related field; advanced certifications in auditing or healthcare compliance are beneficialFamiliarity with OIG best practices and Big-4 Data Analytics is a plus
