California Licensed Audit Investigator

Job Summary

A company is looking for an Investigator External Audit in the Special Investigations Unit.

Key Responsibilities

• Support compliance activities by developing and performing audits and monitoring related to fraudulent billing and coding practices
• Coordinate recovery of overpayments due to fraudulent and/or abusive billing and coding practices
• Provide education on coding, medical record documentation, and healthcare compliance to staff and providers

Required Qualifications

• Bachelor's Degree or equivalent combination of education and experience
• 5 years of coding experience within a healthcare provider, facility, or health insurance company
• 2 years of fraud and abuse audit experience in a relevant healthcare environment
• Experience in project management and education program development
• Experience using data mining software/tools