Healthcare Investigator
Job Summary
Focusing on the review of healthcare claims and documentation, the full-time remote Healthcare Investigator will conduct detailed audits to identify fraud, waste, and abuse while preparing reports and collaborating with internal teams and clients.
Key responsibilities
- Conduct detailed reviews of medical records and claims to identify potential fraud and billing discrepancies
- Document findings and prepare preliminary and final audit reports, ensuring compliance with relevant policies and regulations
- Support legal proceedings by organizing evidence and assisting in expert testimony preparation related to overpayment recovery efforts
Required qualifications
- Strong analytical and investigative skills with experience in reviewing medical claims and billing records
- Working knowledge of healthcare coding, billing practices, and medical necessity criteria
- Understanding of HIPAA requirements and compliance regulations relevant to healthcare audits
- Proficiency with data analysis tools and secure file management systems
- Bachelor's degree in a relevant field
Complete Job Description
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