Fraud Waste and Abuse Analyst

Job Summary

Assisting in the detection and investigation of fraud, waste, and abuse within healthcare services, the full-time Sr. Analyst will leverage analytical skills to review claims data, coordinate with regulatory agencies, and support prevention activities while working remotely.

Key responsibilities

• Review claims data to identify patterns of suspected fraud, waste, and abuse (FWA)
• Assist in the triage and preliminary investigation of FWA complaints and refer cases to regulatory agencies
• Participate in prepayment reviews and collaborate with cross-functional partners on investigations and reporting

Required qualifications

• 3-5 years of relevant work experience
• CPC or equivalent coding certification
• Working knowledge of standard industry coding guidelines such as CPT, HCPCs, and ICD-10
• Experience reviewing medical records to ensure proper documentation of billed services
• Experience interpreting detailed claims data