Special Investigations Unit Investigator

Special Investigations Unit Investigator page is loaded## Special Investigations Unit Investigator remote type:
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Full time posted on:
Posted 2 Days Agojob requisition :
JR100646

Special Investigations Unit Investigator---------------------------------------------------------------This position is responsible for administering the fraud, waste, and abuse (FWA) duties for Care Oregon and its affiliated lines of business. Core work includes ensuring effective measures are in place and operating effectively to prevent, detect, and correct any instances of fraud, waste, and abuse. This includes performing fraud investigations and providing regular FWA reporting. Additionally, this position helps ensure that appropriate procedures are in place and followed consistently to safeguard its assets, verify the accuracy and reliability of data, and promote efficient and effective operations.
** Estimated Hiring Range:**$72,765.00 - $88,935.00
** Bonus Target:
** Bonus - SIP Target, 5% Annual Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

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** Essential Responsibilities
*** Assist in the development and operation of an effective FWA program in accordance with CMS requirements, OHA/OHP requirements, and the Federal Sentencing Guidelines with guidance from department leadership.
* Perform routine FWA investigations, audits, and corrective actions as assigned, including maintaining documents and providing routine updates; may assist senior investigator with more complex or advanced investigations.
* Prepare reports of audit findings; provide recommendations regarding improvements or corrective actions where a deficiency may exist.
* Prepare, proofread, and distribute correspondence, forms, and other information of a specialized and confidential nature.
* Respond to routine and ad hoc requests from external regulatory agencies as assigned, such as annual reviews, quarterly reports, and one-off requests.
* Prepare routine and ad hoc reports for internal and external leaders, committees, and governing body, including collecting, analyzing, and displaying data.
* Assist in developing and maintaining an organized, methodical documentation system for communicating, implementing, and administering new and existing FWA regulatory requirements.
* Review and recommend policy and procedure revisions that support the FWA/SIU program.
* Attend internal and external FWA and compliance-related meetings as assigned.
* Assist in providing effective FWA training and education to staff, both internal and external.
* Educate providers on appropriate documentation and coding.
* Participate in FWA program-related risk assessment and mitigation processes.
* Meet departmental metrics for key performance indicators.##
** Organizational Responsibilities
*** Perform work in alignment with the organization’s mission, vision and values.
* Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
* Strive to meet annual business goals in support of the organization’s strategic goals.
* Adhere to the organization’s policies, procedures and other relevant compliance needs.
* Perform other duties as needed.###
** Experience and/or Education
** Required* Minimum 2 years’ experience in FWA, compliance and/or audit including in an operational setting within a highly regulated industry
* CPC (Certified Professional Coder) or RHIT (Registered Health Information Technician) or CFE (Certified Fraud Examiner Preferred
* Fraud, waste, and abuse experience in healthcare or with health insurance### Knowledge,

Skills and Abilities

Required Knowledge
* Understanding of healthcare fraud, waste, and abuse
* Knowledge of State and Federal compliance and FWA requirements for Medicare and Medicaid
* Knowledge of investigative techniques including interviews, data analytics, evidence gathering, case documentation
* Understanding of information systems

Skills…