Senior Fraud Investigator - VA Licensed (1)

Summary

To support a growing healthcare organization, the full-time Senior Fraud Investigator - VA Licensed will conduct in-depth investigations of suspected fraud and abuse, perform audits, and ensure compliance with health insurance policies, all while working remotely with occasional travel to Virginia Beach.Key responsibilitiesConduct investigations related to fraud or abuse across various interactions involving providers, pharmacies, and membersPerform routine and on-site audits of coding practices and reimbursement systemsPrepare departmental reports and assist in training staff on updated policies and proceduresRequired qualificationsBachelor's Degree in a related field is requiredCertified Professional Coder (CPC) is required (or must be obtained within 12 months of hire)Minimum of 5-8 years of investigative experience or 3-5 years in healthcare investigationsExperience with fraud, waste, and abuse analysis, including data mining and pre-pay investigationsPreferred certifications include Certified Forensic Interviewer (CFI), Certified Fraud Specialist (CFS), and Certified Fraud Examiner (CFE)

Job Description

To support a growing healthcare organization, the full-time Senior Fraud Investigator - VA Licensed will conduct in-depth investigations of suspected fraud and abuse, perform audits, and ensure compliance with health insurance policies, all while working remotely with occasional travel to Virginia Beach.Key responsibilitiesConduct investigations related to fraud or abuse across various interactions involving providers, pharmacies, and membersPerform routine and on-site audits of coding practices and reimbursement systemsPrepare departmental reports and assist in training staff on updated policies and proceduresRequired qualificationsBachelor's Degree in a related field is requiredCertified Professional Coder (CPC) is required (or must be obtained within 12 months of hire)Minimum of 5-8 years of investigative experience or 3-5 years in healthcare investigationsExperience with fraud, waste, and abuse analysis, including data mining and pre-pay investigationsPreferred certifications include Certified Forensic Interviewer (CFI), Certified Fraud Specialist (CFS), and Certified Fraud Examiner (CFE)