Investigator, Special Investigations Unit
1 month ago
Job Summary:
We are seeking a highly skilled Investigator, Special Investigations Unit to join our team at Bestinfo Systems LLC. As an Investigator, you will play a critical role in supporting the timely completion of compliance-related audits and investigations.
Key Responsibilities:
- Support the Special Investigations Unit (SIU) in conducting audits and investigations to identify and correct fraudulent and/or abusive billing and coding practices.
- Collaborate with subject matter experts to identify and investigate complex cases.
- Manage a workload with multiple cases and audits simultaneously, ensuring timely completion and high-quality results.
- Keep organized audit work papers to facilitate collaboration with external teams.
- Coordinate with compliance accountabilities to facilitate corrective action completion and behavior change.
Required Qualifications:
- Bachelor's Degree or equivalent education and experience.
- 5+ years of coding experience at a healthcare provider, facility, or health insurance company.
- 2+ years of fraud and abuse audit experience at a health plan, health insurance company, healthcare provider, facility, or other relevant healthcare environment.
- Experience in using data mining software/tools.
Preferred Qualifications:
- Clinical background, such as Registered Nurse (RN), Doctorate of Medicine (MD), or Doctor of Chiropractic (DC).
- Current certification as Certified Coding Professional (CPC).
Candidate Details:
- Seniority Level: Mid-Senior.
- Minimum Education: Bachelor's Degree.
- Willingness to Travel: Occasionally.
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