Investigator Special Investigation Unit-Health Plan
Investigator Special Investigation Unit-Health Plan
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Salary Not Disclosed
1 Vacancy
Job Description
Location:
Calmont Operations BuildingDepartment:
ComplianceShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
Responsible for supporting the prevention detection investigation reporting and when appropriate recovery of money related to Texas Medicaid Provider fraud waste and abuse within Cook Childrens Health Plans provider network members and staff. Duties include generating accurate and timely analysis and reports to support the SIU preliminary investigation and medical record audit to identify fraud waste and abuse. The position may also work with other internal departments including Compliance Corporate Legal Counsel and the Health Plan Medical Director for additional oversight and compliance with Texas Medicaid Fraud Waste and Abuse regulatory guidelines. Responsibilities include importing transforming and validating data from the SIU team for decisionmaking purposes on identifying provider fraud or provider education.Additional Information:
Education & Experience:
Bachelors degree required.
Must have a minimum of 3 years Medicaid or CHIP fraud waste and abuse investigatory experience.
Knowledge Skills & Abilities:
Extensive knowledge of claim processing with advanced knowledge of medical benefits medical terminology and coding.
Proficient in ICD9/ICD10 and CPT coding.
Knowledge of government programs (Medicaid & CHIP).
One year experience conducting data analysis and reporting.
Must have Microsoft Office skills with Word and Excel.
Certification/Licensure:
CFE through ACFE or NHCAA required or obtain the certification within two years of employment.
About Us:
Cook Childrens Health Plan
Cook Childrens Health Plan provides vital coverage to nearly 120000 people in lowincome families who qualify for governmentsponsored programs in our six county service region. Cook Childrens Health Plan provides health coverage for CHIP CHIP Perinatal STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant Johnson Denton Parker Hood and Wise.
Cook Childrens is an equal opportunity employer. As such Cook Childrens offers equal employment opportunities without regard to race color religion sex age national origin physical or mental disability pregnancy protected veteran status genetic information or any other protected class in accordance with applicable federal laws. These opportunities include terms conditions and privileges of employment including but not limited to hiring job placement training compensation discipline advancement and termination.
Employment Type
Full-Time
