NTT DATA North America
Overview
Join to apply for the
SIU Investigator
role at
NTT DATA North America . Location: Remote (East Coast). The Investigator will be assigned to conduct pre-payment reviews of medical records for healthcare claims in one or more of the following areas: (1) Partial Hospitalization and Intensive Outpatient Programs; (2) Laboratory Testing; and/or (3) Durable Medical Equipment. The Investigator will work under the direction of an experienced pre-payment review investigator and collaborate with other members of the SIU. Reviews are fast-paced and require the Investigator to be organized and efficient in requesting records, reviewing documents, recommending outcomes, and coordinating claim dispositions (payment or denial) within the SIU and with internal business partners. Responsibilities
Drafting and issuing letters to providers requesting clinical records and other relevant documentation Utilizing case management systems to document case work, including correspondence, findings, and an investigative chronology Evaluating claims by applying Plan policies and procedures and generally accepted industry standards of practice Preparing written summaries of findings, supported by evidence collected in the investigation Assisting in preparing fraud referrals to other SIU investigative staff, regulatory agencies, and law enforcement, when appropriate Contacting members, providers, and other relevant parties to obtain additional information about assigned reviews Qualifications
1-3 years of related experience in health insurance fraud investigations, health insurance coding, provider relations, or another similar role Bachelor's degree Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or Accredited Health Care Fraud Investigator (AHFI) preferred Familiarity with Partial Hospitalization and Intensive Outpatient Programs, Laboratory Testing, and/or Durable Medical Equipment preferred Skills
Demonstrated proficiency in Microsoft Word and Excel (including use of analytical tools such as Pivot Tables) Organization and time-management skills About NTT DATA Services
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a presence in more than 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients long-term success. Visit nttdata.com or LinkedIn to learn more. Equal Opportunity Employer
NTT DATA Services is an equal opportunity employer and considers all applicants without regard to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
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Join to apply for the
SIU Investigator
role at
NTT DATA North America . Location: Remote (East Coast). The Investigator will be assigned to conduct pre-payment reviews of medical records for healthcare claims in one or more of the following areas: (1) Partial Hospitalization and Intensive Outpatient Programs; (2) Laboratory Testing; and/or (3) Durable Medical Equipment. The Investigator will work under the direction of an experienced pre-payment review investigator and collaborate with other members of the SIU. Reviews are fast-paced and require the Investigator to be organized and efficient in requesting records, reviewing documents, recommending outcomes, and coordinating claim dispositions (payment or denial) within the SIU and with internal business partners. Responsibilities
Drafting and issuing letters to providers requesting clinical records and other relevant documentation Utilizing case management systems to document case work, including correspondence, findings, and an investigative chronology Evaluating claims by applying Plan policies and procedures and generally accepted industry standards of practice Preparing written summaries of findings, supported by evidence collected in the investigation Assisting in preparing fraud referrals to other SIU investigative staff, regulatory agencies, and law enforcement, when appropriate Contacting members, providers, and other relevant parties to obtain additional information about assigned reviews Qualifications
1-3 years of related experience in health insurance fraud investigations, health insurance coding, provider relations, or another similar role Bachelor's degree Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or Accredited Health Care Fraud Investigator (AHFI) preferred Familiarity with Partial Hospitalization and Intensive Outpatient Programs, Laboratory Testing, and/or Durable Medical Equipment preferred Skills
Demonstrated proficiency in Microsoft Word and Excel (including use of analytical tools such as Pivot Tables) Organization and time-management skills About NTT DATA Services
NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a presence in more than 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients long-term success. Visit nttdata.com or LinkedIn to learn more. Equal Opportunity Employer
NTT DATA Services is an equal opportunity employer and considers all applicants without regard to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.
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