CPC Certified Fraud Investigator

Job Summary

A company is looking for an Associate Fraud and Abuse Investigator.

Key Responsibilities

• Conduct in-depth investigations for suspected fraud or abuse related to various interactions
• Review coding quality through desk and occasional on-site audits
• Assess incoming referrals and assist in investigations of potential fraud, waste, and abuse

Required Qualifications

• Bachelor's Degree or a minimum of 2 years of relevant experience in Medical Coding, Healthcare, or related fields
• Certified Professional Coder (CPC) required, or must achieve within 12 months of hire
• Preferred certifications include Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI)
• Experience in claims investigations or regulatory/compliance roles is beneficial