Special Investigations Unit Investigator

🔥 0 minutes ago

🌵 Arizona, Idaho, +6 more states – Remote

🌵 Arizona – Remote 🥔 Idaho – Remote 🦬 Montana – Remote 🎰 Nevada – Remote 🌲 Oregon – Remote ⛷️ Utah – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $74.3k - $90.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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👻 Ghost score 0%

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Administer fraud, waste, and abuse duties for CareOregon and affiliated lines of business • Develop and operate an effective FWA program in accordance with CMS, OHA/OHP, and applicable legal requirements • Perform routine FWA investigations, audits, and corrective actions • Maintain investigation documents and provide routine updates • Assist senior investigators with complex or advanced investigations • Prepare reports of audit findings and recommend improvements or corrective actions • Prepare, proofread, and distribute specialized and confidential correspondence, forms, and information • Respond to routine and ad hoc requests from external regulatory agencies • Prepare reports for internal and external leaders, committees, and governing bodies by collecting, analyzing, and displaying data • Develop and maintain documentation systems for FWA regulatory requirements • Review and recommend FWA/SIU policy and procedure revisions • Attend FWA and compliance-related meetings • Assist with FWA training and education for internal and external staff • Educate providers on appropriate documentation and coding • Participate in FWA risk assessment and mitigation processes • Meet departmental key performance indicator metrics • Perform work aligned with CareOregon’s mission, vision, values, and strategic goals • Adhere to organizational policies, procedures, and compliance requirements

🎯 Requirements

• Minimum 2 years’ experience in FWA, compliance and/or audit including in an operational setting within a highly regulated industry • Understanding of healthcare fraud, waste, and abuse • Understanding the difference between State Medicaid programs and Medicare • Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid • Knowledge of investigative techniques including interviews, data analytics, evidence gathering, and case documentation • Understanding of information systems • Strong research, investigative, and problem-solving skills • Strong written, verbal, and listening skills • Effective computer skills, including MS Office Suite • Strong interpersonal and motivational skills • Ability to think logically and creatively without undue influence from personal biases • Ability to operate with a high degree of professionalism and confidentiality • Ability to plan, organize, manage, and monitor work projects • Ability to facilitate learning opportunities in informal and formal settings • Ability to make presentations to small and large groups • Ability to bend and speak clearly for at least 3 hours/day • Ability to learn, focus, understand, evaluate information, and determine appropriate actions • Ability to accept direction and feedback, tolerate and manage stress • Ability to see, read, and hear for at least 6 hours/day • Ability to perform repetitive finger and wrist movement for at least 3–6 hours/day • Ability to work effectively with diverse individuals and groups

🏖️ Benefits

• Bonus - SIP Target, 5% Annual • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits eligible employees • Wellness and employee assistance program benefits for non-benefits eligible employees