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Remote Medical Fraud Investigator

Job Attributes

Job Id:

21476

Job Category:

Clinical & Life Sciences

Job Location:

Towson, MD  21204

Security Clearance:

No Clearance

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical Solutions is looking for a motivated Remote Medical Fraud Investigator to support a fraud, waste, and abuse Special Investigations Unit with review and investigations of medical documentation and claims to identify and investigate suspected incidents of fraud, waste or abuse.

 

Responsibilities for the Remote Medical Fraud Investigator:

  • Identify potential instances of fraud, waste, and abuse (FWA) through the investigation and analysis of provider documentation, claims, data and other resources Spoke
  • Conduct interviews and correspond with patients, providers, witnesses and other related parties to determine corrective actions such as settlement, denial, or review
  • Analyze information and data gathered through investigations
  • Utilize data analysis tools and software to analyze and gather pertinent data and information
  • Develop written formal summaries and presentations based on findings and recommendations
  • Support any legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare identified fraudulent cases for civil or criminal actions
  • Negotiate settlement agreements with providers and insurance companies to resolve disputes

Requirements for the Remote Medical Fraud Investigator:

  • 4+ years of medical FWA investigation experience
  • Expert knowledge of Excel data analysis tools and other relevant data analysis software
  • Ability to write formal reports and communicate effectively
  • Active Fraud Certification highly preferred (CFS, CFE, CPC, CFI, CHC, or AHFI)
  • Bachelor’s Degree in related field or Associates Degree with additional professional experience

Compensation for the Remote Medical Fraud Investigator:

  • Salary up to $75,000 based on meeting of requirements
  • Benefits: Health, Dental, & Vision Insurance, 401K

 

Please send all qualified resumes to: idusci@pipercompanies.com

 

Keywords

ICD9, ICD10, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, NCCI, priority partners, DoD, Tricare, Medicare, Medicaid, fraud, waste, abuse, FWA, Utilization Review, UR, CPC, Certified Professional Coder, medical review, coding guidelines, interqual, milliman, program integrity, CMS, Centers for Medicare and Medicaid, part b, part a, medical investigation, fraud investigator, data analysis, data collection, settlement, denial, fraudulent, Accredited Healthcare Fraud Investigator, AHFI, Certified Fraud Specialist CFS, Certified Fraud Examiner, CFE, Certified Forensic Interviewer, CFI, Certified in Healthcare Compliance, CHC, excel, commander, informant, sentinel

 

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New Search

Job Id:

21476

Job Category:

Clinical & Life Sciences

Job Location:

Towson, MD  21204

Security Clearance:

No Clearance

Business Unit:

Piper Companies