Senior Fraud Investigator (CPC Required)

Job Summary

A company is looking for a Senior Fraud and Abuse Investigator- Remote.

Key Responsibilities

• Conduct in-depth investigations for suspected fraud or abuse related to various interactions
• Review the quality of coding in routine desk audits and occasional on-site audits
• Prepare routine department reporting and assist in training staff on policy updates

Required Qualifications, Training, and Education

• Bachelor's Degree in a related field is required
• Certified Professional Coder is required (or must be obtained within 12 months of hire)
• 5-8 years of related investigative experience or 3-5 years in healthcare investigations is required
• Experience in healthcare coding, audit, regulatory, and compliance is required
• Additional certifications such as Certified Fraud Examiner or Certified Healthcare Compliance are preferred