SIU Clinical Healthcare Fraud Investigator III

Title: SIU Clinical Healthcare Fraud Investigator III

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

By applying for this job, you agree to receive AI-generated calls, text messages, and/or emails from Mitchell Martin Inc and its affiliates and contracted partners at various frequency through traditional and automated methods. Message and data rates may apply for texts. Carriers are not liable for delayed or undelivered messages. You can access our privacy policy here

Onboarding Expectations
Learn more about our Onboarding Process here

EEO Statement
Learn more about our EEO policy here