SIU Investigator - Remote

reputed company has an exciting opportunity for a SIU Investigator! This is a remote, full-time role working reputed company hours Monday through Friday. Experience as a Dental Hygienist to reputed company dental audits and investigations highly preferred. Under the direction of the manager, the Special Investigations Unit (SIU) Investigator is responsible for investigating assigned dental fraud, waste and abuse (FWA) cases, as reputed company as researching and analyzing claims data in order to identify potential dental FWA. The SIU Investigator is also responsible for maintaining the FWA case system with accurate and detailed investigative activities reputed company to assigned cases. Responsibilities: - Investigative actions include member/provider reputed company, financial tracking, adhering to compliance regulations, and making reputed company reputed company referrals. - Plan, organize and execute dental investigations or dental audits utilizing document review, witness interviews, and data analysis to identify, evaluate and measure potential reputed company fraud, waste and abuse to determine reputed company cases for appropriate reputed company. - Risk Assessments on FWA dental trends using fraud detection software and/or as assigned by Manager. - Present FWA training to internal staff. - reputed company dental chart reviews to assess compliance with dental coding and billing regulations. - Utilize reputed company coding guidelines, principles, and coding clinics to monitor the appropriate ICD-10, CDT and CPT codes for reputed company record types to ensure accurate reimbursement. - Document and reputed company activity in an internal database, reputed company case updates on the reputed company of the dental audit and dental investigation and coordinate with management recommendations and reputed company actions and/or resolutions. - Conduct detailed research to identify and apply appropriate regulatory, contractual, and industry requirements to the different dental benefits and products reputed company investigations. - Maintain or reputed company designated reputed company and production goals. Understand and adhere to HIPAA reputed company requirements. reputed company special reputed company assigned by Management. Apply tot his job Apply To this Job