Senior Analyst, Fraud, Waste and Abuse Investigation

Role Overview

• Leverage analytical skills to review claims data and identify patterns of suspected potential FWA.
• Assist in the triage, preliminary investigation of all internal and external FWA complaints
• Refer all cases of suspected FWA to regulatory agencies within required timeframes.
• Assist in the monitoring of the FWA hotline and FWA shared email box
• Participate in the prepayment review process including detailed review of medical records against claims data

Requirements

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

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources