FRAUD & ABUSE INVESTIGATOR, SR

Location
Virginia Beach, VA
Posted
Feb 03, 2017
Closes
Apr 01, 2017
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description:
Do you have experience in Fraud Waste and Abuse?
Or Maybe Special Investigations, Regulatory or Compliance?


Optima Health is seeking a talented individual skilled in investigating and auditing medical and behavioral health for fraud, abuse and cost containment. The ideal candidate will be experienced in Claims Fraud, Waste and Abuse Investigation and ready to lead and train additional members of this very specialized team. This niche role can yield from: law enforcement, nursing, clinical coding, medical coding, claims expertise, external auditing and compliance expertise.

Come and join a company where your work in fraud, abuse and investigations is valued and your career is limitless!

Responsible for leading the SIU efforts, providing oversight and guidance to the team. Conducting in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products at Optima Health.

Education Level
Bachelor's Level Degree

Experience
Required: Coding - 5 years, Healthcare - 5 years, Internal/External Audit - 5 years, Regulatory/Compliance - 5 years

Preferred: None, unless noted in the “Other” section below

License
Required: None, unless noted in the “Other” section below

Preferred: Cert Professional Coder

Skills
None, unless noted in the “Other” section below

Other
Bachelors degree and 5 years related experience required. Related experience includes 5 years Coding OR 5 years Healthcare OR 5 years Internal/External Audit OR 5 years Regulatory/Compliance. CPC required within 12 months of hire. Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI) preferred.