Healthcare Fraud Investigator at Integrity Advantage (Remote)
$60k - $92kHireAligned
Levels (Investigator, Sr. Investigator, etc) will depend on experience and qualifications.
Integrity Advantage is a small woman owned business serving health payers and other entities challenged with the detection, investigation and prevention of healthcare fraud, waste and abuse (FWA). We are growing and looking for dynamic, confident and skilled individuals who want to grow with us. Our current need is a healthcare FWA investigator to assist our clients in identifying potential allegations of fraud, conducting investigations and assisting in the recovery process. This is a client facing position , so phenomenal customer service skills are key to being hired for this position.
Essential daily duties and responsibilities:
Perform timely, thorough and well documented investigations
Maintain, organize and prioritize leads and investigations of varying complexity
Gather evidence, research and other information to substantiate or refute allegations
Utilize clients fraud detection solution to identify post-payment or pre-payment opportunities for investigation as well as other applications to perform data mining or track investigative results
Support multiple clients with Medicaid, Medicare, Federal Employee and Commercial lines of business
Communicate status updates to clients as appropriate
Prepare well written investigative reports including any findings from medical record reviews
Knowledgeable in using RAT-STATS for statistically valid random sampling
Ability to provide support to clients for law enforcement referrals, settlement or legal proceedings
Support other initiatives, as required
Required Education / Licenses / Certifications:
Bachelors degree
Accredited Healthcare Fraud Investigator (AHFI) preferred
Experience:
At least 2 years of healthcare claims investigation experience
Knowledge, Skills & Abilities:
Integrity, accountability and confidence
Demonstrated ability to create solutions to problems
Ability to travel for training events, conferences and provide onsite assistance to clients, when needed (appropriate notice will be provided)
Excellent grasp of MS Word, Excel and PowerPoint
Quickly adapt to different anti-fraud technology solutions including ad-hoc query, analytical and case management applications
Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, DRG, and rev codes
Ability to demonstrate professionalism as well as written and oral communication skills
Ability to work independently within a remote team, under minimal supervision
Benefits:
401(k)
Dental insurance
Health insurance
Paid time off
Professional development assistance
Vision insurance
Education:
Bachelor's Degree
License/Certification:
AHFI or CFE or other industry certification
- ...Sponsorship. MedImpact Healthcare Systems, Inc. is looking... ...Description Summary: The Fraud, Waste, and Abuse Investigations Manager handles the... ...high standards of integrity by supporting the Medlmpact... ...necessary changes and taking advantage of opportunities...Remote workContract workLocal areaMonday to FridayFlexible hoursNight shiftWeekend work
$73.2k - $109.8k
...Senior Fraud Investigator Volkswagen Financial Services, a wholly-owned... ...Classification of Fully Remote. Salary range is dependent... ...for annual performance bonus Healthcare benefits 401(k), with company... ...Tool, refine output and integration with processes and other VCI...Remote workWork from home- ...Investigating allegations of potential healthcare fraud and abuse, the full-time SIU Investigator will conduct claims investigations, perform data analysis, and prepare detailed reports while working remotely from various locations. Key responsibilities Conduct investigations...Remote workFull time
$85k - $105k
...Healthcare Fraud Investigator Employment Type: Full-Time, Mid-Level CGS is seeking a Healthcare Fraud Investigator to provide legal support for a large government project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete...Remote workFull timeWork experience placementWork at officeLocal area- ...Corporation is hiring for a Fraud Prevention Analyst.... .... Youll combine investigation, analytics, and risk management... ..., WI office or remotely from Wisconsin, Arizona... ...level of ownership and integrity Willingness to... ...benefits administration, healthcare, or another regulated...Remote workWork at officeFlexible hours
- ...managed care contracts, the full-time Payment Integrity Specialist will ensure compliance with... ...maximize reimbursement while working remotely. Key responsibilities Review and... ...Required qualifications Associate degree in healthcare or business-related field, or a minimum...Remote workFull timeContract workWork from home
$65k - $88.6k
...part of our caring community The Fraud and Waste Professional conducts investigations of allegations of fraudulent and... ...skills to make an impact WORK STYLE: Remote/Work at Home (minimal travel, <5%... ...At least 3 years of healthcare fraud investigations and/or auditing...Remote workWeekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$61.91k - $118.25k
...UMG Fraud Prevention Analyst UMG's fraud prevention team is... ...role will be responsible for investigating and documenting ongoing patterns... ...European office locations or remote. How You'll Create... ...detection, AML/KYC, or platform integrity systems is highly desirable....Remote workSummer workWork at officeImmediate startFlexible hours- ...Apply Refer a Friend Back Remote Work from Home Share This Page... ...including Tuition Reimbursement The Revenue Integrity Charge Capture Analyst serves as subject... ...degree preferred, preferably in business or healthcare Coding certification (CPC, CCS, CCS-P...Remote workFull timeLocal areaWork from homeDay shift
- ...focused on advocacy and program integrity through compliance management... ...of care, and influence healthcare outcomes on ameaningful scale... ...for vulnerable populations Remote work - enjoy the convenience... ...policies and identify potential fraud, waste, or abuse. Review...Remote workFull timeTemporary workWork at officeWork from home
- ...Norton Healthcare is seeking a qualified candidate for a fully remote coding position. The role focuses on resolving billing edits and conducting audits to ensure compliance with revenue integrity standards. Applicants must have three years of coding experience and relevant...Remote work
- ...Fraud Decisioning Analyst At U.S. Bank, we're on a journey to do our best. Helping... ...performance. Ensure analytical rigor and data integrity, validating assumptions, methodologies,... ...for applicants. Benefits: ~ Healthcare (medical, dental, vision) ~ Basic term...Temporary workWork experience placementWork at officeShift work3 days per week
- A healthcare company is seeking a Remote Revenue Integrity Charge Capture Analyst I. This role involves maintaining the Charge Description Master and ensuring compliance with billing and coding regulations. Candidates must reside in Massachusetts or nearby states and have...Remote work
$81.7k - $113.4k
...Digital Fraud Investigator At Municipal Credit Union, we believe that an incredible culture helps create a happy and motivated team that... ...or urgent investigative escalations. Uncompromising integrity and the ability to handle sensitive, confidential, and legally...Remote workLocal areaFlexible hours- ...Xtend Healthcare is seeking a DRG Revenue Integrity Auditor to perform DRG validation and chart reviews for inpatient records. You will apply ICD-10-CM/PCS... ...classifications and compliant documentation. This remote role offers a salaried schedule, opportunities for professional...Remote work
- A healthcare organization is seeking a Remote Revenue Integrity Charge Specialist to support its revenue cycle and integrity initiatives. In this role, you will analyze and capture data, audit billing information, and ensure accurate documentation. The ideal candidate has...Remote work
- A healthcare integrity solutions provider is looking for an Outpatient Payment Integrity Coder Auditor in New York City. In this role, you will audit outpatient medical claims for coding accuracy and compliance with CMS guidelines. The ideal candidate must have advanced...Remote work
- A leading healthcare solutions provider is seeking a Revenue Integrity/Accounts Receivable Representative to enhance financial performance through accurate billing and charge capture. This remote role requires strong analytical skills, 2+ years of experience in physician...Remote workFlexible hours
- A prominent healthcare organization is looking for a MuleSoft Developer to support critical data integrations for one of the leading cancer research institutes. This role is fully remote and involves designing and maintaining APIs while ensuring data is accurately exchanged...Remote work
$55.1k - $99k
...adherence to regulatory standards related to program integrity. This position requires a Bachelor's degree and... ..., compliance, or legal roles, ideally within healthcare. The role offers the flexibility to work remotely from anywhere in the Continental United States and...Remote work$114.08k - $218.03k
...at USAA, where our core values – honesty, integrity, loyalty and service – define how we... ...duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military... .... The Opportunity As a dedicated Fraud Strategy Analyst Senior , you will be...Remote workH1bWork at office$69 per hour
...Job Summary The Clinical Documentation Integrity Specialist (CDIS) facilitates the overall quality, completeness, and accuracy of clinical... ...interaction with providers and other members of the healthcare team. The CDIS ensures that documentation accurately reflects...Remote workDaily paidWork at office$53.96k - $86.18k
...FRAUD TEAM SUPPORT ANALYST Responsible for analytical and project... ...and Perks Comprehensive healthcare coverage, including Medical,... ...entrepreneurs and that legacy of integrity, community and unparalleled client... ...otherwise indicated as fully remote, reporting into a designated...Remote work- ...Join to apply for the Fraud Risk Analyst role at First Bank (FBNC... ...Risk Analyst who will be an integral member of our first line Fraud... ...high-risk transactions to investigating and validating leads, to proactively... ...card transactions, mobile remote deposit capture and remote...Remote work
$110k - $120k
...reality. Our drive to transform healthcare is informed by our blend of... ...#LifeatRealChem. AI Integration Engineer We're looking... ...meetings with managers, taking advantage of on-site learning, and connecting... ...regions, where people work remotely but come together quarterly...Remote workWork experience placementWork at officeLocal areaFlexible hours2 days per week- ...Job Title: Epic Integration Analyst Location: Remote Duration: Part time Contract About BigRio BigRio is a Boston-headquartered technology... ...and custom software solutions with a strong focus on healthcare and regulated industries. We partner with healthcare...Remote workContract workPart time
- ...Business Analyst-Healthcare Integration BigRio is a Boston-based, remote-first technology consulting firm specializing in advanced data and software solutions. We partner with forward-thinking organizations to deliver scalable, cost-effective, and innovative technology...Remote work
- ...Sentara Health in Bristol, VA is looking to hire an Integrated Case Manager, RN. This is a remote position; however, candidates must reside in Bristol and surrounding areas as travel is required. The Integrated Case Manager is responsible for case management services within...Remote work
$53 per hour
...ETL Developer / Data Integration Professional Remote $53/hr Responsibilities Develop and optimize complex SQL queries for data extraction, transformation, and loading across multiple systems and large datasets. Perform data mapping and transformation between source and...Remote work- ...Responsibilities The Senior Integration Analyst works under general direction to define high... ...seamless data exchange between diverse healthcare systems. Conducts thorough testing and validation... ...analysts. THIS POSITION OFFERS A FULLY REMOTE WORK OPPORTUNITY. EMPLOYEES IN THIS ROLE...Remote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Healthcare Fraud Investigator at Integrity Advantage (Remote). Be the first to apply!

