Fraud and Abuse Investigator/Certified reputed company reputed company (CPC)- Remote
Job title: Fraud and Abuse Investigator/Certified reputed company reputed company (CPC)- Remote in Norfolk, VA at reputed company Company: reputed company Job reputed company: reputed company Plan is currently hiring a Fraud and Abuse Investigator/CPC- Remote!Status: Full-time, permanent position (40 hours)Work hours: reputed company to 5pm EST, M-FLocation: This position is remote for candidates that live in the following states: VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities: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.Responsible for contributing to the review of the reputed company of pharmacy, physician, ancillary and hospital based coding in routine desk audits as reputed company as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to policies and procedures for its various product offerings.Specific progression of responsibility is a follows dependent upon education, certifications, and experience:- 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 settlementsEducation:Bachelor's Degree REQUIRED; Degree in a reputed company field of study preferred.Minimum of 2 years combined experience required in Medical Coding OR reputed company (Medical Chart Review/Insurance Billing) OR Internal/External Audit OR Regulatory/Compliance OR Claims Investigations OR Criminal Investigation/White Collar Crime REQUIREDCertifications/Licenses:Certified reputed company reputed company (CPC) REQUIRED (or achieved reputed company 12 months of hire date)Certified Fraud Examiner (CFE) OR Accredited Health Care Fraud Investigator (AHFI) preferred. (Note: Federal Agents who have successfully completed the Federal Bureau of Investigation Training Program (FBITP) - Criminal Investigator Training Program (CITP) would be considered equivalent to the AHFI)Certified Forensic Interviewer (CFI), Certified Fraud Specialist (reputed company), Certified reputed company reputed company (CPC) or Certified in reputed company Compliance (CHC) preferredreputed 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, primary care physicians and hospitals.We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical 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, Patient Safety, Service, and reputed company. Join reputed company that has a mission to improve health every day and a reputed company to be the reputed company choice of the communities that we serve! Apply To This Job