Clinical Fraud Investigator II
Jobtailor
Responsibilities Performs comprehensive analysis and clinical evaluation of the collected data Performs in-depth investigations on identified providers as warranted Examines claims for compliance with relevant billing and processing guidelines Review and conduct retrospective analysis of claims and medical records prior to payment Research new healthcare related questions as necessary to aid in investigations Collaborate with the Special Investigation Unit and other internal areas on matters of mutual concern Recommend possible interventions for loss control and risk avoidance based on the outcome of the investigation Requirements Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) Minimum of 4 years related experience Minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area Advanced Excel skills, including Pivot Tables Core Competencies Demonstrates expertise in clinical evaluation and fraud investigation within healthcare, utilizing advanced analytical skills and compliance knowledge to ensure adherence to billing guidelines and risk management strategies. Tools & Technologies Excel #J-18808-Ljbffr
Vacancy posted 3 days ago
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