Investigator
JOB SUMMARY:
Job Title: Investigator-Medical
Department: Special Investigations Unit
Reports To: Director, Special Investigations
Position Summary:
The Investigator- Medical will be responsible for effectively carrying out investigations of alleged Fraud, Waste and Abuse by providers, members and others.
Essential Duties and Responsibilities:
· Conduct independent investigations involving providers, members and others relating to Fraud, Waste and Abuse
· Assist SIU Director and Senior Investigator with Fraud, Waste and Abuse issues
Work Experience/Qualifications:
5 to 8 years of relevant experience required.
Education Requirements:
Employee is required to possess an a Associates Degree.
Technical Skills:
Employee is required to have Basic skills with Sales Logic, MHS, and Market Prominence and intermediate MS Office and MS Outlook.
Physical Demands:
While performing the duties of this job, the employee is occasionally required to walk, bend, stand, drive and travel and constantly sit and key.
Work Environment:
While performing the duties of this job, the employee constantly works in an indoor environment.
Additional Information:
Both NY and NJ require SIU investigators to meet certain education and experience requirements:
Associate’s or bachelor’s degree in criminal justice or related field, or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies, or seven years of professional investigative experience involving economic or insurance related matters.
Applicant must have expert knowledge of medical claims processing and investigations.
Experienced in CPT/HCPCS/ICD-9 codes and medical terminology.
Strong critical thinking and analytical skills
The ability to read medical records
Conditions of Employment:
Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.
Disclaimer:
The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status.
Requirements:
For consideration apply online at www.healthfirstny.org