Investigator External Audit Special Investigations Unit - Remote

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. Responsibilities include the identification, investigation, and correction of fraudulent and/or abusive billing and coding practices; coordination of recovery of over payments related to such practices;

and providing education on coding, medical record documentation requirements, healthcare compliance, and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities.

• Washington
• Oregon
• California

• 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.

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

• 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

Our best‑in‑class benefits are uniquely 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.

At Providence, our strength lies in our promise of “Know me, care for me, ease my way.” Working at our family of organizations means that, regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best‑in‑class benefits and foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.

Together, our 120,000 caregivers serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.