Healthcare Investigator

Providing investigative support for special investigation unit (SIU) activities, the full-time Healthcare Investigator will focus on the prevention, detection, and investigation of healthcare fraud, waste, and abuse (FWA), while working remotely to analyze information and ensure compliance with coding and billing guidelines. Key responsibilities Develop leads and conduct assessments and investigations into allegations of FWA, including interviews and data analysis Complete investigations within mandated timeframes and prepare detailed reports and referrals to regulatory agencies Coordinate with internal departments to gather documentation and provide education on appropriate coding practices Required qualifications At least 2 years of investigative experience in the healthcare industry or equivalent education and experience Knowledge of managed care, Medicaid, Medicare, and claim billing codes Proven investigatory skills with the ability to analyze risks and remain objective Understanding of data analytics and regulatory requirements related to healthcare Valid and unrestricted driver's license