Investigator, Special Investigations Unit

1 month ago


Beaverton, Oregon, United States Bestinfo Systems LLC Full time
Job Title: Investigator, Special Investigations Unit

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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