Special Investigations Unit Investigator

🔥 0 minutes ago

🌲 Oregon, Washington – Remote

🌲 Oregon – Remote ☕ Washington – Remote

💵 $74.3k - $90.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

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 (FWA) duties for CareOregon • perform fraud investigations • provide regular FWA reporting • develop and operate an effective FWA program in accordance with CMS requirements • perform routine FWA investigations, audits, and corrective actions • prepare reports of audit findings • respond to routine and ad hoc requests from external regulatory agencies • prepare routine and ad hoc reports for internal and external leaders • assist in developing and maintaining documentation system for FWA regulatory requirements • review and recommend policy and procedure revisions • attend internal and external FWA and compliance-related meetings • assist in providing effective FWA training and education to staff • educate providers on appropriate documentation and coding

🎯 Requirements

• Minimum 2 years’ experience in FWA, compliance and/or audit in a highly regulated industry • Oregon Medicaid experience or health plan experience preferred • CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner) • Understanding of healthcare fraud, waste, and abuse • Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid • Knowledge of investigative techniques including interviews, data analytics, evidence gathering, case documentation • Strong research, investigative and problem-solving skills

🏖️ Benefits

• 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 • multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.) • strong retirement plan with employer contributions • PTO and Paid State Sick Time • paid holidays, volunteer time, jury duty, bereavement leave, and more