Investigator, Specical Investigation Unit-Health Plan
Investigator, Specical Investigation Unit-Health Plan
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Location:
Calmont Operations BuildingDepartment:
ComplianceShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
Additional Information:
Responsible for supporting the Cook Childrens Health Plans SIU Manager in the prevention detection investigation reporting and when appropriate recovery of money related to Texas Medicaid Fraud Waste and Abuse Program regulations. Duties include generating accurate and timely analysis and reports to support the SIU preliminary and fullscale investigations and medical record audits to identify possible 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 guidance. Responsibilities include importing transforming and validating data from the SIU analytics tool for decisionmaking purposes on identifying potential fraud.
Education & Experience
Bachelors degree required.
Must hold credentials such as certification from the Association of Certified Fraud Examiners as a Certified Fraud Examiner (CFE) an accreditation from the National Health Care AntiFraud
Association as an Accredited Health Care Fraud Investigator (AHFI)
OR
Have previous law enforcement experience with a minimum of 3 years Medicaid or CHIP fraud waste and abuse investigatory experience.
Knowledge Skills & Abilities
Knowledge of claim processing with advanced knowledge of medical benefits medical terminology and coding.
Proficient in ICD10 and CPT coding.
Knowledge of government programs (Medicaid & CHIP).
Knowledge of data analysis and reporting.
Must have Microsoft Office skills with Word and Excel.
Licensure Registration and/or Certification
Certified Fraud Examiner or an Accredited Health Care Fraud Investigator required.
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
