Coder-Senior Investigator

Overview

Now hiring a Coder-Senior Investigator

The Senior Investigator supports the Program Integrity Manager and department investigators. This role assists with developing, implementing, and performing fraud, waste, and abuse related auditing and monitoring activities. This includes the identification, investigation and correction of fraudulent, wasteful, 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. This person must develop excellent professional relationships with internal and external partners and providers and their representatives, other payers, regulatory agencies, local healthcare law enforcement and accrediting bodies. The ideal candidate should have advanced experience in claims fraud, waste and abuse investigation

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Qualifications

• Bachelors degree and 5 years related experience required (related experience includes 5 years Healthcare Coding, 5 years Healthcare/Investigations, 5 years Internal/External Audit, OR 5 yearsRegulatory/Compliance).
• 6 years of additional experience can be substituted in lieu of degree.
• CPC or equivalent required
• Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred

Responsibilities

• Investigational experience
• Procedural coding
• Technical writing
• Analysis
• Ability to learn
• Critical thinking and attention to detail.Advanced communication:
• Facilitating meetings
• Authoring articles & letters to members & providers
• Engaging with all levels of staff and management within the organization, committee members, as well as the public
• Proofreading work of team members
• Broad view of enterprise
• Demonstrated ability to communicate effectively in person and via telephone with members, …