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Investigator External Audit Special Investigations Unit *Remote*
Investigator External Audit Special Investigations Unit *Remote*Providence Health Plan Group • California, MO, US
Investigator External Audit Special Investigations Unit •Remote •

Investigator External Audit Special Investigations Unit •Remote •

Providence Health Plan Group • California, MO, US
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Description

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.

Providence Health Plan caregivers are valued and integral to our mission. This role participates in a culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect.

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 Coding experience with a healthcare provider, facility or health insurance company.
  • 2 years 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

    • Why Join Providence Health Plan?

    Our best-in-class benefits are designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

    About Providence

    Providence is an Equal Opportunity Employer. We are committed to a diverse and inclusive workforce where everyone is essential, heard and respected.

    About the Team

    Providence Shared Services provides functional and system support services across our organization. We support our Mission by delivering a robust foundation of services and shared expertise.

    The base pay range is listed; additional compensation may be available for such as shift differentials, standby / on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including retirement 401(k) with employer matching, health care benefits, life insurance, disability insurance, time off benefits, voluntary benefits, well-being resources, and more. Learn more at providence.jobs / benefits.

    Applicants in certain regions should refer to applicable local ordinances for fair chance hiring as applicable.

    About the Team (continued)

    Requisition ID : 390963 | Company : Providence Jobs | Job Category : Internal Audit | Job Function : Finance | Job Schedule : Full time | Job Shift : Day | Career Track : Business Professional | Department : 5018 COMPLI PAYMENT INTEGRITY OR REGION | Address : CA Oakland 540 23rd St | Work Location : Providence House Oakland-Oakland | Workplace Type : Remote

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    Investigator • California, MO, US