Clinical Fraud and Abuse Investigation Role

2 days ago


Grand Prairie, Texas, United States Elevance Health Full time
About Elevance Health
Elevance Health is a health company dedicated to improving lives and communities. Our mission is to provide innovative solutions and exceptional services to our members and the communities we serve. We are committed to creating a culture that values diversity, equity, and inclusion.

Job Summary: We are seeking a skilled Clinical Fraud Investigator II to join our team. The successful candidate will be responsible for identifying potential risks associated with fraud and abuse in the healthcare industry. Key responsibilities include conducting data mining activities, performing comprehensive analysis and clinical evaluation of collected data, and collaborating with internal teams to address matters of mutual concern.

Key Responsibilities:
* Conducts data mining activities using available tools and internal data warehouse.
* Performs comprehensive analysis and clinical evaluation of the collected data.
* Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.

Requirements:
* Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA).
* Minimum of 4 years related experience, including at least 1 year in a Clinical Fraud and Abuse Investigation area.

What We Offer:
A competitive salary, ranging from $70,140 to $120,240 per year, based on location and experience. You will also enjoy a comprehensive benefits package, including merit increases, paid holidays, Paid Time Off, incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

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