SIU Clinical Healthcare Fraud Investigator III
Mitchell Martin
SIU Clinical Healthcare Fraud Investigator III
Lead complex investigations into suspected healthcare fraud, waste, and abuse. Independently manage investigations from intake through closure. Develop strategies and prepare evidentiary packages for referrals. Collaborate cross-functionally to safeguard organizational integrity. Provide clinical and operational insight into billing patterns. Act as a resource and mentor for other staff.
Conduct complex clinical investigations involving misconduct. Coordinate with law enforcement and regulatory agencies. Analyze patterns and emerging schemes in healthcare fraud. Prepare comprehensive reports and referral packets. Mentor junior investigators and contribute to detection controls.
At least 4 years of coding experience. At least 3 years conducting healthcare fraud investigations. Expertise in clinical documentation review and regulatory compliance. Strong understanding of coding and reimbursement structures. Proven ability to mentor others and manage multiple investigations.
Mitchell MartinVacancy posted 3 days ago
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