SIU Investigator III (Must live in Arkansas)
Core
Investigate and resolve high-complexity allegations of healthcare fraud, waste, and abuse by medical professionals and facilities; analyze provider billing data to identify trends and patterns.
Role type
Senior IC healthcare fraud investigator
Builds
Investigative reports, corrective action plans, and litigation support documents
Domain
Healthcare compliance and fraud investigation
Deliverable
client delivery
Required skills
Healthcare fraud investigation, medical coding (CPT/HCPCS/ICD), Medicaid/Medicare law interpretation, data analytics, audit execution, complex interview techniques, legal case development
Preferred skills
Master's degree in relevant field, Certified Professional Coder (CPC), knowledge of medical terminology, complex project management
Technologies
Microsoft Office (Excel, Access, PowerPoint), RAT STATS
Responsibilities
Develop and conduct strategic fact-driven investigative projects; manage production and validation of reports from claims and clinical data; coordinate on-site and desk audits; prepare and conduct in-depth interviews; execute provider corrective action plans; present research to seek approval for formal actions; collaborate with legal counsel and law enforcement agencies
Seniority
Senior, hands-on IC
