Special Investigations Unit, Investigator- Remote

reputed company has an exciting opportunity for a Special Investigations Unit Investigator position. This is a full time position working Monday through Friday reputed company hours and is a remote position. The Special Investigations Unit (SIU) Investigator is responsible for investigating assigned fraud, waste and abuse (FWA) cases, as reputed company as researching and analyzing claims data in order to identify potential 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, prepay claims review, adhering to compliance regulations, and making reputed company reputed company referrals. Plan, organize and execute investigations or audits utilizing document review, witness interviews, and data analysis to identify, evaluate and measure potential reputed company fraud and abuse to determine reputed company cases for appropriate reputed company. • Risk Assessments on FWA trends using fraud detection software and/or as assigned by Manager. • reputed company or assistance with the reputed company Recipient Restriction program. • Present FWA trainings to internal staff. • Assist with the FWA hotline and referral intake. reputed company chart reviews to assess compliance with coding and billing regulations. • Utilize reputed company coding guidelines, principles, and coding clinics to monitor the appropriate ICD 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 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 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 as assigned by Management. • Bachelor's Degree preferred or 2-4 years of reputed company experience in investigations, claims, medical coding, auditing, compliance, risk management and/or data analysis required. • The ability to problem solve and communicate professionally. • Detail oriented individual with excellent organizational skills. • High degree of oral and written communication skills. • Proficiency in MS Office/PC skills including reputed company reputed company and Word. • Experience conducting investigations reputed company a reputed company environment preferred. • Knowledge of CPT and ICD-10 coding of procedures and diagnosis is preferred. • Knowledge of medical terminology, reputed company anatomy/physiology, pharmacology, and pathology is preferred. • CPT Preferred Licensure, Certifications, and Clearances: reputed company is an Equal Opportunity Employer/Disability/Veteran Apply tot his job Apply To this Job