Senior Clinical Fraud and Waste Investigator - RN and Coding Credential required - REMOTE Anywhere in US

Profile

Description

The Senior Clinical Fraud and Waste Professional performs analysis of clinical investigations of allegations of fraudulent and abusive practices. The Senior Clinical Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Clinical Fraud and Waste Professional coordinates investigation with SIU Investigators and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications


Bachelor's degree
Active Registered Nurse (RN) license in applicant's state of residence
CPC (Certified Professional Coder) certification
Minimum of 1 year of healthcare fraud investigations or auditing experience
Proficient in MS Office applications including Word, Excel, Outlook and PowerPoint
Solid understanding of healthcare payment methodologies
Understanding of healthcare industry, claims processing and investigative process development
Ability to work independently and manage work load
Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills Inquisitive nature with ability to analyze data to metrics
Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession


Preferred Qualifications


SIU Fraud experience- strongly preferred
2 years recent experience with coding experience- strongly preferred
Advanced Excel proficiency
AHFI or CFE certification
Access and SharePoint experience
Experience in a corporate environment and understanding of business operations


Additional Information

Scheduled Weekly Hours

40

Company info

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