FRAUD & ABUSE INVESTIGATOR, SR - Alabama Community Care Team

Location
Virginia Beach, VA
Posted
May 09, 2017
Closes
May 30, 2017
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description:
Optima Health has an opening for a Fraud & Abuse Investigator. This position is full time, day shift, with the potential for a remote option for residents in Virginia and North Carolina. This is an exciting opportunity to work in support of our new Alabama Community Care expansion team located in Virginia Beach, VA.

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.