Enabling a high-quality and viable healthcare system
Senior Investigator – Pre-Pay, Healthcare FWA
Location
United States
Posted
51 days ago
Salary
$70K - $90K / year
Seniority
Senior
Job Description
Senior Investigator – Pre-Pay, Healthcare FWA
Cotiviti
• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. • Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation. • Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance. • Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse. • Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation. • Conducts investigation-related training. • Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions. • Maintain current knowledge of relevant laws, regulations and standards. • Complete all responsibilities as outlined on annual Performance Plan. • Complete all special projects and other duties as assigned.
Job Requirements
- Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
- 5-8 years of related healthcare FWA investigative experience.
- Experience in proactive data mining.
- Advanced level skills in Excel required.
- Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions).
- Excellent verbal and written communication skills.
- Strong listening and observation skills.
- Attention to detail and high level of accuracy.
- Effective organizational and prioritization skills with multi-tasking ability.
- Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC).
Benefits
- medical, dental, vision, disability, and life insurance coverage
- 401(k) savings plans
- paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti
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