Bringing our heart to every moment of your health.
Senior SIU Investigator
Location
Louisiana
Posted
12 hours ago
Salary
$47.0K - $91.8K / year
Seniority
Senior
Job Description
Senior SIU Investigator
CVS Health
• conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse • Handle high profile or highly sensitive matters involving cases that are national in scope • Investigate matters of program integrity to prevent payment of aberrant claims • Conduct thorough research on subject(s) and related entities • Initiate proactively data mining using SIU Tools to identify aberrant billing patterns • Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme • Research and prepare cases for clinical and legal review • Accurately document all case activity and communications in designated case tracking system • Communicate clinical findings to provider • Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing
Job Requirements
- Must reside in Louisiana
- 5+ years investigative experience in healthcare fraud and abuse matters
- Working knowledge of medical coding; CPT, HCPCS, ICD10
- Proficient in Microsoft Office with advanced skills in Excel (pivot tables are a must, Power BI, etc.)
- Strong analytical ability to view and slice claims data in multiple facets
- Self-starter: initiates research that will be vital to an investigation
- Proficient in researching information and identifying new resources helpful to all cases
- Strong verbal and written communication skills (using correct grammar, spelling, sentence structure, etc.)
- Ability to travel up to 10%
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package designed to support physical, emotional, and financial well-being
Related Guides
Related Categories
Related Job Pages
More General Jobs
• Modify and/or adapt the K12 curriculum in alignment with state’s content standards • Collaborate with general education teachers for student goals • Educate parents on instructional strategies • Ensure the implementation of the RTI instructional system • Collect and maintain all RTI data
• Delivering specific course content in an online environment • Providing instruction, support, and guidance to students • Monitoring student progress through Stride K12’s learning management system • Actively working closely with students and parents/learning coaches • Preparing students for high stakes standardized tests • Establishing and maintaining positive rapport with families
• Deliver specific course content in an online environment • Provide instruction, support, and guidance tailored to students’ needs • Communicate with parents and staff for student therapies • Develop compliant IEPs and progress reports • Facilitate collaborative special education meetings • Analyze student data to prescribe remediation and enrichment
• Deliver specific course content in an online environment • Provide instruction, support, and guidance to students • Monitor student progress through learning management system • Collaborate with students and parents for their learning needs • Travel occasionally for school functions
