Job Details

Overview

Investigator External Audit Special Investigations Unit Remote

The SIU Audit Investigator supports the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities.

Responsibilities

• Identify, investigate and correct fraudulent and/or abusive billing and coding practices
• Coordinate recovery of overpayments related to fraudulent and/or abusive billing and coding practices
• Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities

Qualifications

• Bachelor's Degree Or equivalent combination of education and experience
• 5 years Coding experience with a healthcare provider, facility or health insurance company
• 2 years Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment
• Project management experience, education program development experience and group presentation experience
• Experience in use of data mining software/tools

Preferred Qualifications

• Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire
• Certification as an Internal Auditor or Healthcare Compliance certification upon hire
• Clinical background

Location

Remote; Providence Health Plan supports 100% remote work for applicants in Washington, Oregon and California.