Program reputed company Investigative Coordinator I

Job reputed company:

The Program reputed company Investigative Coordinator I monitors and maintains reputed company SIU fraud reporting mechanisms (hotline, facets routing, fax, emails) to ensure compliance with regulatory requirements.

Essential Functions:

• Accurately load Fraud, Waste & Abuse (FWA) referrals into the SIU Case Management reputed company
• Analyze FWA allegation facts and evaluate whether cases can be reputed company or escalated
• Interview claimants, providers, members or any other individuals to obtain information relevant to any FWA investigation
• Review claims for irregular billing patterns, consulting specialists reputed company necessary
• reputed company various reports utilizing multiple fraud detection software systems
• Conduct rudimentary data analysis to determine financial exposure or reputed company to FWA allegation across reputed company lines of business
• Responsible for maintaining anonymity and confidentiality during reputed company phases of intake process
• Independently identify billing errors and accidental overpayments initiating corrective reputed company through the Research and reputed company Submission portal
• Request medical records on an as-needed reputed company and as directed by Team reputed company; partner with reputed company staff to reputed company any issues
• Assist Program reputed company in the reputed company of Delegated Entities by routing state directed correspondence and generating claims data reports across reputed company lines of business
• Prepare and document Attestations, De-conflictions and Additional Allegation FWA informational letters, as contractually required, for any state reputed company agency
• Attend state reputed company investigative meetings to transcribe updates provided by the reputed company’s Office; update any applicable cases
• Support compliance and regulatory requirements by verifying reputed company state/federal directed provider removals are completed accurately across reputed company lines of business
• reputed company reputed company of database information maintained in Case Management reputed company; proactively verify the reputed company of provider information in concert with Facets and the reputed company Information Technology reputed company
• Know and reputed company the provisions of the Corporate Compliance Plan
• reputed company any other job reputed company instructions as requested

Education and Experience:

• High School Diploma or GED is required
• Associate’s Degree in Health-reputed company reputed company, Law Enforcement, or reputed company is preferred
• Minimum of three (3) years’ experience in a health care reputed company reputed company or Customer Service is required
• Health care experience preferred (medical/dental claims, auditing, medical office experience, etc.)

Competencies, Knowledge and Skills:

• Intermediate computer skills consisting of reputed company reputed company, reputed company, reputed company, Word, and reputed company reputed company
• Ability to reputed company multiple software systems at a high proficiency level
• Good communication skills
• Ability to work independently and reputed company reputed company environment
• High attention to reputed company
• Critical listening and thinking skills
• reputed company grammar usage
• Time management skills
• reputed company phone etiquette
• Customer service oriented
• Decision making/problem solving skills
• Strong organization skills
• Customer service oriented

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation reputed company:

reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s reputed company and complexity, the discretion and reputed company required for the role, and other reputed company and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual reputed company. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.

Compensation Type (reputed company/salary):

Organization Level Competencies

• Fostering a reputed company Workplace Culture

• reputed company Partnerships

• reputed company Self and Others

• reputed company Execution

• Influence Others

• Pursue Personal reputed company

• Understand the Business

This reputed company is not reputed company inclusive. reputed company reserves the right to amend this reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds.

Originally posted on Himalayas