Healthcare Fraud Waste Abuse Investigator (Part-time, Remote) Job at Integrity Management Services, Alexandria, VA

M0hMWUNCaGFXT3lBelkwVEpFb2hDc2JpTlE9PQ==
  • Integrity Management Services
  • Alexandria, VA

Job Description

Description

Responsibilities

  • Identify and conduct investigations into known or suspected FWA with high autonomy
  • Develop documentation to substantiate findings including formal reports graphs audit logs and other supporting documentation.
  • Perform root cause analysis to inform future algorithmic identification of similar claims or cases and associated savings (i.e. help move identified case types from pay-and-chase to preventive edits and pre-payment activity)
  • Participate in the development and presentation of FWA-related education for assigned Customers
  • Perform coding reviews for flagged claims to support Coding team (if applicable).

Requirements
  • Minimum of 2 years of experience in healthcare claims analysis auditing payment integrity or a related field.
    • Bachelors degree in Criminal Justice or a related field or at least 3 years of insurance claims investigation experience or professional investigation experience with law enforcement agencies.
  • Knowledge of applicable fraud statutes and regulations and of federal guidelines on recoupments and other anti-FWA activity
  • Experience handling confidential information and following policies rules and regulations
  • Experience with commercial Medicare or Medicaid claims
  • Strong analytical and problem-solving skills with attention to detail and accuracy
  • Excellent communication skills both written and verbal for effective collaboration with internal teams and external providers
  • Proficiency in Microsoft Office particularly Excel and familiarity with claims processing or audit software
  • Certified Fraud Examiner (CFE) Accredited Healthcare Fraud Investigator (AHFI) Certified AML (Anti-Money Laundering) and Fraud Professional (CAFP) or similar is preferred
  • Certified Professional Coder (CPC) or similar is preferred

Job Tags

Part time, Work at office, Remote work,

Similar Jobs

Heritage and Company, Inc. MBE

Landscape Laborer- Union Wages Job at Heritage and Company, Inc. MBE

 ...Were Hiring: Landscape Laborers & Foremen (Union Positions) Join our growing team union membership not required to apply Are you ready to build your career with a respected landscaping construction team? Were hiring Landscape Laborers and Foremen to work... 

Forsyth Periodontics & Implants

Dental Assistant Job at Forsyth Periodontics & Implants

 ...Cumming location Dental Office looking for a candidate with EXCEPTIONAL customer service...  ...who is willing to learn to be both an assistant and administrator with our dental family...  ...for growth in future. No direct dental experience needed, but it is a plus! Part time or full... 

Fawkes IDM

Office Administrator (law firm experience required) Job at Fawkes IDM

 ...Responsibilities: Works with the office attorneys and staff to support the offices goals for high quality service to internal and...  ...management; including significant experience in a national multi-office law firm, preferably in the Metropolitan area 5+ years of... 

Privia Health

Urgent Care Physician Assistant Job at Privia Health

 ...Urgent Care Physician Assistant Job Description: We are currently hiring a family nurse practitioner or physician assistant to join our primary/urgent care hybrid clinic in Warrenton and/or Woodbridge, VA on a full-time, part-time or PRN basis. Outstanding... 

Obsidian Security

AI GTM Engineer Job at Obsidian Security

 ...prevent breaches at the source. Our team includes leaders who helped define the categories of endpoint and identity security at CrowdStrike Okta Cylance and Carbon Black. Now were transforming how SaaS is securedin the era of agentic AI. Today Obsidian is trusted...