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Senior Fraud amp Waste Investigator - Remote
Location
Dover, DE, United States
Posted on
Feb 13, 2021
Profile
Job Information
Humana
Senior Fraud & Waste Investigator - Remote
in
Dover
Delaware
Description
Are you looking to be a part of a Fortune 100 company with competitive salary, opportunity for growth, great benefits, amazing 401K and the ability to work permanently from home? Do you love to gather and investigate clinical information in order to provide plan of action recommendations? Do you take the initiative to go above and beyond, and work independently with little supervision required? Well, if you answered YES to one or more of the above you should strongly consider Humana's Senior Nurse Investigator opportunity.
Responsibilities
The Senior Nurse Fraud and Waste Investigator coordinates investigation with SIU Investigators. Assembles clinical documentation to support successful adjudication, where appropriate. Prepares complex clinical investigative and audit reports. Begins to influence department's strategy. Makes decisions on moderately complex-to-complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Required Qualifications
Licensed Registered Nurse
2 years recent experience as a CPC (Certified Professional Coder)
Minimum of 1 year of healthcare fraud investigations or auditing experience
Knowledge of healthcare payment methodologies
Understanding of healthcare industry, claims processing and investigative process development
Strong organizational, interpersonal, and writing/verbal communication skills
Inquisitive nature with ability to analyze data to metrics
High level of emotional intelligence
Computer skills (Word, Excel and SharePoint)
Strong personal and professional ethics
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1 mbs upload) is required
Preferred Qualifications
Bachelor's degree
AHFI or CFE certification
Access and SharePoint experience
Experience in a corporate environment and understanding of business operations
Scheduled Weekly Hours
40
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