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Presbyterian Healthcare Services · 2 days ago

Coder-Healthcare Fraud Investigator

United States

Full-time

Remote

Mid Level

$51K/yr - $78K/yr

3+ years exp

Presbyterian Healthcare Services is a not-for-profit healthcare system committed to improving the health of patients and communities. They are seeking a skilled Fraud Investigator to support Program Integrity efforts by conducting complex investigations into suspected healthcare fraud, waste, or abuse.

AssociationHealth Care

H1B Sponsor Likely

Responsibilities

Conduct complex investigations involving providers, pharmacies, employees, members, and brokers

Perform detailed medical coding audits and analyze referral-based fraud, waste, or abuse cases

Prepare accurate reports, legal documents, and referrals for government agencies

Maintain thorough case documentation in the SIU case management system

Communicate effectively with government agencies, providers, and internal teams

Use multiple systems to analyze claims and detect fraudulent patterns

Research coding rules and regulations to support investigations

Resolve conflicts from audit findings and manage post-audit case reviews

Collaborate on investigations and recommend process improvements

Conduct audits, recover overpayments, and educate providers on billing practices

Qualification

Healthcare claims investigationsMedical coding auditsCertified Professional CoderCertified Professional Medical AuditorCertified Fraud ExaminerCommunication skillsCollaboration skillsConflict resolution

Required

Bachelors degree, plus three years related healthcare experience required. Six years of additional experience can be substituted in lieu of degree

Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or equivalent required

Preferred

Certified Professional Medical Auditor (CPMA) through the AAPC

Certified Fraud Examiner (CFE) or Accredited Health Care Fraud Investigator (AHFI)

Benefits

Medical

Dental

Vision

Short-term and long-term disability

Group term life insurance

Other optional voluntary benefits

Employee Wellness rewards program

Company

Presbyterian Healthcare Services

Glassdoor3.6

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities they serve.

Founded in 1908

Clovis, New Mexico, USA

10001+ employees

http://www.phs.org

H1B Sponsorship

Presbyterian Healthcare Services has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (90)

2024 (86)

2023 (85)

2022 (93)

2021 (86)

2020 (76)