Associate Fraud and Abuse Investigator, Certified Professional Coder (CPC)

Job not on LinkedIn

🔥 2 minutes ago

🏈 Alabama, Florida, +24 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌪️ Kansas – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $32 - $45 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

👻 Ghost score 0%

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Contribute to in-depth investigations of suspected fraud or abuse involving providers, pharmacies, employers, members, and brokers across the full range of products • Contribute to routine desk audits and occasional on-site audits reviewing pharmacy, physician, ancillary, and hospital-based coding quality • Review reimbursement systems for health insurance claims processing and ensure adherence to policies and procedures • Triage and prioritize leads and member complaints from internal sources • Review and assess referrals and assist in investigating potential fraud, waste, and abuse • Conduct research supporting investigations • Collect and evaluate suspicious patterns in claims data, provider enrollment data, and other sources, referring cases to investigators for investigation or settlement • Ensure accurate reimbursement and compliant coding practices • Maintain comprehensive case files • Participate in special projects as required • Travel to Virginia Beach once a year

🎯 Requirements

• Bachelor's Degree REQUIRED OR minimum of 2 years combined experience required in Medical Coding, Healthcare (Medical Chart Review/Insurance Billing), Internal/External Audit, Regulatory/Compliance, Claims Investigations, or Criminal Investigation/White Collar Crime • Certified Professional Coder (CPC) REQUIRED or achieved within 12 months of hire date • Certified Fraud Examiner (CFE) OR Accredited Health Care Fraud Investigator (AHFI) preferred • Professional Writing • Verbal Communication • Time Management • Complex Problem Solving/Critical Thinking • Microsoft Excel and Word • Microsoft Access and Outlook • Must live in one of the listed states: VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, or WY • Available to work 8am to 5pm EST, Monday through Friday • Full-time availability, 40 hours per week

🏖️ Benefits

• Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Pet Insurance • Legal Resources Plan • Annual discretionary bonus opportunity if established system and employee eligibility criteria is met • Paid military leave • Voluntary benefits