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SIU Clinical Healthcare Fraud Investigator III
Mitchell Martin
🇺🇸 United States
Remote
1 month ago
$45.00 – $55.53 / hour
- Regulatory Compliance
1 month ago
Not enough detail in this posting to match
Location:Remote
Position Type:Contract
Compensation
Pay Range:$45.00-$55.53 Per Hr
Description
Lead complex investigations into suspected healthcare fraud, waste, and abuse.
Independently manage investigations from intake through closure.
Develop strategies and prepare evidentiary packages for referrals.
Collaborate cross-functionally to safeguard organizational integrity.
Provide clinical and operational insight into billing patterns.
Act as a resource and mentor for other staff.
Key Responsibilities
Conduct complex clinical investigations involving misconduct.
Coordinate with law enforcement and regulatory agencies.
Analyze patterns and emerging schemes in healthcare fraud.
Prepare comprehensive reports and referral packets.
Mentor junior investigators and contribute to detection controls.
Qualifications
At least 4 years of coding experience.
At least 3 years conducting healthcare fraud investigations.
Expertise in clinical documentation review and regulatory compliance.
Strong understanding of coding and reimbursement structures.
Proven ability to mentor others and manage multiple investigations.
Contact Authorization:
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Onboarding Expectations
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SIU Clinical Healthcare Fraud Investigator III · Mitchell Martin