Providence · 10 hours ago
Investigator External Audit Special Investigations Unit - Remote
United States
Full-time
Remote
Mid, Senior Level
$29.62/hr - $45.31/hr
5+ years expProvidence is a comprehensive health care organization dedicated to serving vulnerable communities. The Investigator External Audit Special Investigations Unit supports compliance activities by developing and performing auditing and monitoring related to fraudulent billing practices and providing education on healthcare compliance.
Hospital & Health Care
Responsibilities
Assist the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan
Identify, investigate and correct fraudulent and/or abusive billing and coding practices
Coordinate recovery of overpayments related to fraudulent and/or abusive billing and coding practices
Provide education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities
Qualification
Required
Bachelor's Degree Or equivalent combination of education and experience
5 years Coding experience with a healthcare provider, facility or health insurance company
2 years Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment
Project management experience, education program development experience and group presentation experience
Experience in use of data mining software/tools
Preferred
Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire
Certification as an Internal Auditor or Healthcare Compliance certification upon hire
Clinical background
Benefits
401(k) Savings Plan with employer matching
Health care benefits (medical, dental, vision)
Life insurance
Disability insurance
Time off benefits (paid parental leave, vacations, holidays, health issues)
Voluntary benefits
Well-being resources
Company
Providence
Every day, 119,000 compassionate caregivers serve patients and communities through Providence St.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brad Henry
Chief Executive Officer at Providence Willamette Falls Medical Center
Ranjit S. Hundal, MD, MBA, CPE, FACP, SFHM
Interim Chief Executive Officer
Recent News
2025-09-23
2025-09-13
Company data provided by crunchbase