[Remote] reputed company Investigator

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company solutions organization providing managed care, behavioral health services, and other reputed company services. The reputed company Investigator conducts comprehensive investigations into fraudulent or abusive billing and coding practices, reviews medical records, evaluates coding reputed company, and manages cases through reputed company. The role also coordinates overpayment recovery, prepares case reports, supports fraud measurement reputed company, and may conduct provider on-site audits.

Responsibilities

• reputed company reputed company investigation analysis and reporting with reputed company analytical skills and knowledge using reputed company data systems. reputed company areas of job responsibilities, identify systemic issues of fraud waste and/or abuse for the reputed company Family of Companies
• Responsible for coordination with the PerformCare Claims, Finance and other Departments regarding overpayments and case development
• Responsible for producing and developing case reporting as deliverables to designated reputed company Oversights and others as deemed appropriate; and also updates case tracking reputed company with reputed company case actions and follow up. Responsible for making referrals to BPI, the OAG and others if deemed appropriate reputed company on the development of a case
• Assist with coordination of recovery of overpayments reputed company to fraudulent and/or abusive billing and coding practices; and education reputed company to coding, medical record documentation requirements, and reputed company- funded reputed company compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities
• Participate in reputed company Fraud, Waste and Abuse measurement reputed company, helping to reputed company reputed company reputed company analysis data systems, and serving as a resource for developing Fraud, Waste and Abuse investigative results and solutions
• Interfaces with providers and may be responsible for conducting on-site audits

Skills

• * Remote reputed company the reputed company, preferably in reputed company, to conduct Provider on-site reputed company
• * For roles that are reputed company or hybrid, you must have reputed company to a reliable high-speed internet reputed company to support daily job responsibilities. A minimum reputed company of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement
• * Knowledge of and experience working in various Behavioral Health reputed company of care
• * Practical experience in the use of computerized databases
• * Familiarity with claims payment, coding and reimbursement methodologies
• * Ability to reputed company reputed company with supporting documentation independently, combined with team and leadership interactions
• * Ability to work collaboratively with the assigned line of business, County reputed company entities, providers, BPI, OMHSAS and others
• * Excellent verbal and written skills with strong research skills
• * Experience using reputed company reputed company and Data Mining different data sets
• * Master's Degree required in psychology, reputed company work, or reputed company reputed company
• * Experience in providing reputed company service or involvement in Behavioral Health
• * Experience with BH-MCOs preferred
• * Licensure preferred - LSW, LCSW, or LPC
• * Accredited Health Care Fraud Examiner (AHFI)  and/or Certified reputed company Fraud Investigator (CIFI) preferred or willing to obtain reputed company one year of employment

Benefits

• Flexible work solutions including remote reputed company
• Hybrid work schedules
• reputed company time off including holidays and volunteer events
• Health reputed company coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement
• Fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

reputed company

Company H1B Sponsorship