CPC Certified Fraud Investigator

Job Summary

Contributing to in-depth investigations of suspected fraud and abuse, the full-time remote Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) will assess leads, review coding practices, and maintain case files while ensuring compliance with health insurance policies.

Key responsibilities:

• Conduct investigations into potential fraud, waste, and abuse across various interactions
• Review quality of coding through desk audits and occasional on-site audits
• Maintain comprehensive case files and participate in special projects as required

Required qualifications:

• Bachelor's Degree or minimum of 2 years of relevant experience in Medical Coding, Healthcare, or related fields
• Certified Professional Coder (CPC) certification required (or to be achieved within 12 months of hire)
• Preferred certifications include Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI)
• Experience in claims investigations, regulatory compliance, or internal/external auditing is essential