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Investigator External Audit Special Investigations Unit

Investigator External Audit Special Investigations Unit

ProvidenceOregon, WI, US
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Investigator External Audit Special Investigations Unit

Remote

The SIU Audit Investigator supports the compliance-related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance-related auditing and monitoring activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and / or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and / or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers / facilities.

Responsibilities

  • Assist the External Audit Senior Manager with developing, implementing and performing compliance-related auditing and monitoring activities at the Health Plan.
  • Identify, investigate and correct fraudulent and / or abusive billing and coding practices.
  • Coordinate recovery of overpayments related to fraudulent and / or abusive billing and coding practices.
  • Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers / facilities.

Providence Health Plan context

Providence Health Plan caregivers are valued and integral to our culture of patient-focused, whole-person care. Providence Health Plan welcomes 100% remote work for applicants who reside in the following states :

  • Washington
  • Oregon
  • California

    • Required Qualifications

  • Bachelor's Degree or equivalent combination of education and experience.
  • 5 years of coding experience with a healthcare provider, facility or health insurance company.
  • 2 years of Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment.
  • Project management experience, education program development experience and group presentation experience.
  • Experience in use of data mining software / tools.

    • Preferred Qualifications

  • Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire.
  • Certification as an Internal Auditor or Healthcare Compliance certification upon hire.
  • Clinical background.

    • Salary Range by Location

  • California : Humboldt — Min : $29.62, Max : $45.31
  • California : All Northern California - Except Humboldt — Min : $33.23, Max : $50.84
  • California : All Southern California - Except Bakersfield — Min : $29.62, Max : $45.31
  • California : Bakersfield — Min : $28.41, Max : $43.47
  • Oregon : Non-Portland Service Area — Min : $26.49, Max : $40.52
  • Oregon : Portland Service Area — Min : $28.41, Max : $43.47
  • Washington : Western - Except Tukwila — Min : $29.62, Max : $45.31
  • Washington : Southwest - Olympia, Centralia & Below — Min : $28.41, Max : $43.47
  • Washington : Tukwila — Min : $29.62, Max : $45.31
  • Washington : Eastern — Min : $25.28, Max : $38.68
  • Washington : South Eastern — Min : $26.49, Max : $40.52

    • About Providence

    Providence is committed to an inclusive workplace where diversity is valued and every caregiver is essential, heard, and respected. We serve across multiple states with a focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. The base pay range is listed; additional compensation may be available (e.g., shift differentials, on-call, overtime, bonuses). Learn more at providence.jobs / benefits.

    About The Team

    Providence Shared Services provides functional and system support services across our family of organizations, delivering a robust foundation of services and sharing specialized expertise.

    Providence is an Equal Opportunity Employer, committed to a workforce free from unlawful discrimination and harassment. We embrace diversity and provide equal opportunities for advancement.

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