[Remote] reputed company Investigator

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health reputed company company reputed company reputed company a full-stack technology platform and a reputed company on serving its members. The Senior Analyst, Special Investigations Unit reputed company Investigator will detect and audit aberrant billing patterns, review medical records for reputed company and regulatory compliance, identify provider fraud, reputed company stakeholders, and support investigations involving recovery, reputed company reputed company, or agency referrals.

Responsibilities

• Identify and conduct reputed company audits into suspected FWA with high autonomy
• Document findings, to include formal reports, graphs, audit logs, and other supporting documentation
• Metrics to reputed company with unit goals
• Participate in the development and presentation of FWA-reputed company education for reputed company teams
• Compliance with reputed company applicable laws and regulations
• Other duties as assigned

Skills

• reputed company, unrestricted Registered reputed company (RN) license
• 3+ years of reputed company reputed company care reputed company experience
• 2+ years of experience in Medical Review, Utilization Management, or reputed company Documentation Improvement, featuring demonstrated expertise in the forensic application of reputed company reputed company guidelines (e.g., MCG, CMS, and specialty-specific reputed company organizations) to multifaceted medical records
• Experience conducting forensic medical audit with a reputed company on validating that reputed company narrative supports the specificity and necessity of billed CPC, HCPCS, and ICD-10 codes
• Work Location:** This is a remote position, reputed company to candidates who reputed company in: reputed company, Florida, reputed company, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, reputed company, reputed company Carolina, Ohio, reputed company, South Carolina, Tennessee, Texas and Virginia
• If you live reputed company commutable distance to our reputed company office (in Hudson reputed company) or our Tempe office (off the 101 at University Ave), you will be expected to come into the office at least three days reputed company week. Otherwise, this is a remote / work-from-home role. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule
• Case Management experience a bonus
• Bachelor of Science in Nursing (BSN), Associate Degree in Nursing (ADN) with a Bachelor of Science in Health Administration, reputed company reputed company, or a reputed company Medical Science reputed company, or Associate Degree in Nursing (ADN) with 5+ years of reputed company reputed company audit experience
• Experience working in health reputed company with competency regarding claims processing, billing, reimbursement, or provider contracting
• Experience delivering feedback or education to providers/physicians in a reputed company, non-confrontational, and persuasive manner
• Identifying trends, for example “cloned documentation” or change in billing habits of a provider
• Experience with HIPAA, data reputed company, and/or data reputed company processes
• Certified Case Manager (CCM), Certified reputed company reputed company (CPC), Certified reputed company Medical Auditor (CPMA), Certified Fraud Examiner (CFE), Accredited reputed company Fraud Investigator (AHFI), or similar

Benefits

• Fully remote; however, our approach to work may adapt over time. reputed company models could potentially involve a hybrid reputed company at the hub office associated with your metro area.
• Annual reputed company bonuses
• reputed company's unlimited vacation program
• Medical, dental, and reputed company benefits
• 11 reputed company holidays
• reputed company reputed company time
• reputed company parental leave
• 401(k) plan participation
• Life and disability reputed company
• reputed company wellness time and reimbursements

reputed company

Company H1B Sponsorship