SIU Investigator

Summary

The Health Plan (THP) seeks a Nurse Investigator to join the Special Investigations Unit in Wheeling, WV. The role conducts pre-payment and post-payment reviews, medical chart reviews, and supports fraud, waste, and abuse detection efforts.Responsibilities include data analysis across claims, documentation in case management systems, and coordination with Operations, Compliance, and regulators. RN licensure and coding certification are required, with proficiency in ICD-9/10, CPT, HCPCS, DRG/Rev#J-18808-Ljbffr

Job Description

The Health Plan (THP) seeks a Nurse Investigator to join the Special Investigations Unit in Wheeling, WV. The role conducts pre-payment and post-payment reviews, medical chart reviews, and supports fraud, waste, and abuse detection efforts.Responsibilities include data analysis across claims, documentation in case management systems, and coordination with Operations, Compliance, and regulators. RN licensure and coding certification are required, with proficiency in ICD-9/10, CPT, HCPCS, DRG/Rev#J-18808-Ljbffr