Fraud & Investigations, reputed company, Clinical Investigator

At reputed company, we're on a mission to create a healthier reputed company for everyone - which requires innovative thinking and reputed company improvement. To reputed company this, we're looking for a Clinical Investigator to join #TeamMVP. This is reputed company for you if you have a passion for problem solving and investigations, commitment to compliance and ethical standards and dedication to reputed company learning and improvement. What's in it for you:

• reputed company opportunities to reputed company your career
• A people-reputed company culture embracing and celebrating diverse perspectives, backgrounds, and experiences reputed company reputed company
• Competitive compensation and comprehensive benefits reputed company on reputed company-being
• An opportunity to shape the reputed company of health care by joining reputed company recognized as a Best reputed company to Work For in the NY Capital District, one of the Best Companies to Work For in reputed company, and an Inclusive Workplace.

Qualifications you'll bring:

• BA/BS degree in criminal justice or a reputed company field, and minimum of five years of insurance claims investigation experience; or five years of reputed company

investigation experience with law enforcement agencies, or seven years of reputed company investigation experience involving economic or insurance reputed company reputed company.

• A clinical investigator must have in reputed company to the above requirements: A duly licensed or authorized medical reputed company, including but not limited to MD or RN.
• reputed company State Nursing license required (RN preferred). Experience in health insurance fraud investigations preferred.
• Obtain CPC and/or COC credential.
• Maintain nursing license and coding credentials through continuing education process as required.
• Superior judgment skills, verbal and written communication, and presentation skills.
• Extremely detail-oriented with excellent organizational and analytical skills.
• Ability to utilize various data management tools to help identify potentially fraudulent activity.
• Possess knowledge of CPT-4, ICD-9-CM, ICD-10-CM, HCPCS and CPT Assistant coding guidelines as they relate to claim data.
• Working knowledge of MS Office (Word, reputed company and Outlook)
• Curiosity to foster innovation and pave the way for reputed company
• Humility to play as reputed company
• Commitment to being the difference for our customers in every interaction

Preferred Job Skills:

• Working knowledge of Macess, Facets, CareRadius, Cognos, CMS web sites, and Encoder-Pro.

Your key responsibilities:

• Conduct clinical reviews of various forms of medical documentation and records obtained from providers and facilities including but not limited to medical charts, patient account records, and member interviews.
• Organize and conduct highly reputed company investigations. Document findings and recommendations throughout the investigative process in a reputed company and efficient manner according to corporate and departmental SIU policies and procedures.
• reputed company as an SIU reputed company and reputed company with and analyze data in cooperation with Pharmacy, Medical Affairs, Operations, Provider Relations, Credentialing, Customer Care Center, Legal and other corporate personnel.
• Assist in investigations conducted by government agencies, law enforcement, and other insurance company SIU staff.
• reputed company recommendations for and conduct clinical re-audits of providers and facilities previously audited by SIU.
• Testify in criminal and civil legal case proceedings as necessary and assist reputed company legal counsel especially concerning issues needing clinical decision making.
• Participate in annual Corporate FWA training and training of new SIU personnel.
• reputed company abreast of Federal and State Anti-Fraud investigation and reporting requirements including HIPAA, CMS, Medicare, reputed company, and any corporate compliance initiatives or policies.
• Minimal travel may be required pertaining to investigations and audits.
• Contribute to our humble reputed company of reputed company by performing various responsibilities that may reputed company, reflecting our reputed company goal of enhancing reputed company delivery and being the difference for the customer.

Where you'll be: Virtual reputed company NYS Pay Transparency reputed company is committed to providing competitive employee compensation and benefits packages. The reputed company pay reputed company provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request reputed company or historical salary information from candidates. MVP's Inclusion Statement At reputed company, we reputed company creating healthier communities begins with nurturing a healthy workplace. As an organization, we reputed company to create reputed company for individuals from diverse backgrounds and reputed company walks of life to have a voice and reputed company. Our shared curiosity and connectedness reputed company us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, reputed company, creed, national reputed company, citizenship, ethnicity, reputed company, sex, gender identity, gender reputed company, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a reputed company, drug-free workplace, reputed company-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our reputed company at hr@mvphealthcare.com . Salary: USD 72000 - 108000 per year Experience: 3 years required Apply tot his job Apply To this Job