Presbyterian Healthcare Services
Coder-Senior Healthcare Fraud Investigator
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Overview
Now hiring a
Coder-Senior Healthcare Fraud Investigator The Senior Investigator supports the Program Integrity Manager and department investigators. This role assists with developing, implementing, and performing fraud, waste, and abuse related auditing and monitoring activities. This includes the identification, investigation, and correction of fraudulent, wasteful, and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements. This person must develop excellent professional relationships with internal and external partners and providers and their representatives, other payers, regulatory agencies, local healthcare law enforcement, and accrediting bodies. The ideal candidate should have advanced experience in claims fraud, waste, and abuse investigation. We're committed to supporting healthcare workers. Presbyterian is dedicated to improving people's lives — the lives of our patients and coworkers. We're a locally owned and operated organization, which encourages supportive leadership that empowers employees. We also provide opportunities for growth from entry-level to senior positions. Why Join Us Full Time - Exempt: Yes Work hours: Days Benefits: We offer a wide range of benefits including medical, wellness programs, vision, dental, paid time off, retirement, and more for full-time employees. Ideal Candidate: Bachelor's degree and
5 years Healthcare Coding, Healthcare Investigations, Internal/External Audit, OR Regulatory/Compliance experience Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred Qualifications Bachelor's degree and 5 years related experience required (including Healthcare Coding, Investigations, Audit, or Compliance) 6 years of additional experience can substitute for a degree CPC or equivalent required Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred Responsibilities Investigational experience Procedural coding Technical writing Analysis and critical thinking Ability to learn and attention to detail Effective communication, including facilitating meetings, authoring articles and letters, engaging with staff and management, proofreading, and customer service skills Proficiency in MS Office, Adobe Pro, Internet Guide others in developing work plans and processes Collaborate with investigators and assist with medical record analysis Determine billing and reimbursement appropriateness Identify training needs and provide education Abstract CPT, HCPCS, Revenue Codes, DRG, ICD-9/ICD-10 from records Maintain knowledge of coding guidelines and regulations Perform other functions as required Benefits All benefits-eligible Presbyterian employees receive a comprehensive package including medical, dental, vision, disability, life insurance, and voluntary benefits. Wellness
Presbyterian's Employee Wellness rewards program offers opportunities to enhance health and well-being, with incentives like gift cards for participating in wellness activities. Why work at Presbyterian?
We are committed to community health, partnering with local organizations to improve health outcomes. About Presbyterian Healthcare Services
We are a not-for-profit healthcare system serving New Mexico since 1908, with hospitals, a health plan, and a growing medical group. We employ nearly 14,000 staff and serve over 580,000 members through various health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses. Maximum offer for this position is up to USD $45.82/hr. Compensation depends on experience, training, and organizational needs.
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Coder-Senior Healthcare Fraud Investigator The Senior Investigator supports the Program Integrity Manager and department investigators. This role assists with developing, implementing, and performing fraud, waste, and abuse related auditing and monitoring activities. This includes the identification, investigation, and correction of fraudulent, wasteful, and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements. This person must develop excellent professional relationships with internal and external partners and providers and their representatives, other payers, regulatory agencies, local healthcare law enforcement, and accrediting bodies. The ideal candidate should have advanced experience in claims fraud, waste, and abuse investigation. We're committed to supporting healthcare workers. Presbyterian is dedicated to improving people's lives — the lives of our patients and coworkers. We're a locally owned and operated organization, which encourages supportive leadership that empowers employees. We also provide opportunities for growth from entry-level to senior positions. Why Join Us Full Time - Exempt: Yes Work hours: Days Benefits: We offer a wide range of benefits including medical, wellness programs, vision, dental, paid time off, retirement, and more for full-time employees. Ideal Candidate: Bachelor's degree and
5 years Healthcare Coding, Healthcare Investigations, Internal/External Audit, OR Regulatory/Compliance experience Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred Qualifications Bachelor's degree and 5 years related experience required (including Healthcare Coding, Investigations, Audit, or Compliance) 6 years of additional experience can substitute for a degree CPC or equivalent required Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) preferred Responsibilities Investigational experience Procedural coding Technical writing Analysis and critical thinking Ability to learn and attention to detail Effective communication, including facilitating meetings, authoring articles and letters, engaging with staff and management, proofreading, and customer service skills Proficiency in MS Office, Adobe Pro, Internet Guide others in developing work plans and processes Collaborate with investigators and assist with medical record analysis Determine billing and reimbursement appropriateness Identify training needs and provide education Abstract CPT, HCPCS, Revenue Codes, DRG, ICD-9/ICD-10 from records Maintain knowledge of coding guidelines and regulations Perform other functions as required Benefits All benefits-eligible Presbyterian employees receive a comprehensive package including medical, dental, vision, disability, life insurance, and voluntary benefits. Wellness
Presbyterian's Employee Wellness rewards program offers opportunities to enhance health and well-being, with incentives like gift cards for participating in wellness activities. Why work at Presbyterian?
We are committed to community health, partnering with local organizations to improve health outcomes. About Presbyterian Healthcare Services
We are a not-for-profit healthcare system serving New Mexico since 1908, with hospitals, a health plan, and a growing medical group. We employ nearly 14,000 staff and serve over 580,000 members through various health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses. Maximum offer for this position is up to USD $45.82/hr. Compensation depends on experience, training, and organizational needs.
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