Denver Health · 4 weeks ago
Payment Integrity Investigator - Must Reside in Colorado
Denver, CO
Full-time
Onsite
Entry, Mid Level
$59K/yr - $88K/yr
2+ years expDenver Health is an integrated, high-quality academic health care system that includes a Level I Trauma Center and various health services. The Payment Integrity Investigator is responsible for detecting and investigating fraud, waste, and abuse in healthcare, collaborating with departments to ensure compliance and integrity within the organization.
Health CareHospitalMedical
Responsibilities
Conduct proactive FWA detection and monitoring via various techniques and tools including, but not limited to, data mining and analytics. (10%)
Collaborate with DHMP departments and leadership to investigate allegations of FWA. (10%)
Perform analysis of applicable regulations, contracts, and policy manuals to determine whether violations exist. (10%)
Collect, analyze, and document evidence related to FWA investigations and/or projects to include, but not limited to: (10%)
Conducting and documenting interviews of witnesses or subjects. (10%)
Perform field work to include provider site visits and surveillance. (10%)
Compile and organize accurate case file documentation and calculation of potential overpayments. (5%)
Make referrals of case findings to appropriate law enforcement and/or regulators. Develop investigative summary reports documenting investigative activities and findings. (5%)
Suggest program integrity measures and controls to enhance FWA prevention work. (5%)
Serve as a resource for departments to research and resolve integrity inquiries and assist in identification of improvements to internal practices that may reduce or prevent FWA. (5%)
Represent DHMP as a witness in court actions as required, and in affidavits as assigned. (5%)
Support other team members within the Corporate Compliance Department, as assigned. (5%)
Participate in preparing and submitting required reporting to regulatory agencies. (5%)
Respond to data requests submitted by external authorized parties. (5%)
Qualification
Required
Bachelor's Degree Required or High School Diploma or GED Required and Demonstrated experience. Required
1-3 years At least two years of experience performing investigations or audits in the health care arena. Required
CPC - Certified Professional Coder - AAPC - American Academy of Professional Coders Required
Knowledge of medical terminology, healthcare claims, and medical coding
Demonstrated experience using data to perform investigations or audits, including intermediate skill level with Excel
Knowledge of Medicare and Medicaid requirements
Proficiency in Microsoft Office
Benefits
Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Company
Denver Health
Denver Health is a health care organization providing level one care for all, regardless of ability to pay.
5001-10000 employees
Funding
Current Stage
Late StageTotal Funding
$1MKey Investors
Health Resources and Services AdministrationCDA Foundation
2024-11-22Grant· $1M
2024-03-18Grant
Leadership Team
Leticia Leyva
Administrative Director. CEO's Office
Ansar Hassan
Interim CFO / Senior Finance Director
Recent News
2025-10-09
Seattle TechFlash
2025-09-12
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