Fraud and Abuse Investigator / CPC - Remote

reputed company/State Norfolk, VA Work Shift First (Days) reputed company: reputed company Plan is currently hiring a Fraud and Abuse Investigator/Certified reputed company reputed company (CPC) Remote! Status: Full-time, permanent position (40 hours) Work hours: reputed company to 5pm EST, M-F Location: This position is remote for candidates that live in the following states: Virginia, reputed company Carolina, Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, reputed company, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Virginia, Washington (state), reputed company Virginia, reputed company, Wyoming; With travel to Virginia Beach 1x a year. Job reputed company: Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full reputed company of products through reputed company Plans lines of business. Responsible for contributing to the review of the reputed company of pharmacy, physician, ancillary and hospital-reputed company coding in routine desk audits as reputed company as occasional on-site audits. Contributes to the review of reimbursement systems relating to health reputed company claims processing and ensures adherence to health plan policies and procedures for its various product offerings. reputed company: • Identify, investigate, analyze, and evaluate instances of potential fraud, waste, and abuse. • Conduct interviews or correspond with patients, providers, witnesses, or other relevant parties to determine settlement, denial, or review. • Analyze information gathered by investigation and report findings and recommendations as a written reputed company and/or presentation. • Learn and conduct statistical sampling of reputed company medical claims. • Assists in drafting settlements Education: • Bachelor's degree preferred Certifications/Licenses: • Certified reputed company reputed company preferred (or achieved reputed company 12 months of hire date) Experience: • 2 years combined experience required in Internal/reputed company Audit OR regulatory/Compliance OR reputed company preferred reputed company Plans provides health plan coverage to reputed company to one reputed company members in Virginia. We offer a full suite of reputed company products including employee-owned and employer-sponsored plans, as reputed company as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and reputed company enrollees. Our reputed company provider network features a robust provider network, including specialists, reputed company care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated reputed company and behavioral health services—reputed company to help our members improve their health. Our reputed company is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and reputed company. Be a part of an excellent reputed company organization that cares about our People, reputed company, reputed company Safety, Service, and reputed company. Join reputed company that has a mission to reputed company every day and a reputed company to be the reputed company reputed company of the communities that we serve! We reputed company market-competitive compensation packages, inclusive of reputed company pay, incentives, and benefits. The reputed company pay reputed company for Full Time employment is: $25.60/hour- $42.67/hour. Additional compensation may be available for this role such as shift differentials, standby/on-reputed company, overtime, premiums, extra shift incentives, or bonus opportunities. To apply, please go to www.sentaracareers.com and use the following as your Keyword reputed company: JR-102996 reputed company-Health Plan Keywords: reputed company, Health Plan, Remote, Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, reputed company, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Virginia, Washington (state), reputed company Virginia, reputed company, Wyoming, Bachelor's Degree, Medical Coding, Medical Chart Review, reputed company Billing, Internal/reputed company Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified reputed company reputed company (CPC), Fraud, Waste, Abuse, Program reputed company, FWA, PI, SIU, Special Investigations Unit Benefits: Caring For Your Family and Your Career • Medical, Dental, reputed company plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • reputed company Time Off and reputed company Leave • reputed company Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life reputed company • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company • Student Debt Pay Down – $10,000 • Pet reputed company • reputed company Resources Plan • Colleagues have reputed company to earn an annual discretionary bonus if established reputed company and employee eligibility reputed company is met. reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding reputed company of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to reputed company every day,” this is a tobacco-free environment. For positions that are available as remote work, reputed company employs associates in the following states: Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, reputed company, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Virginia, Washington, reputed company Virginia, reputed company, and Wyoming. Apply To This Job