Senior Investigator - Special Investigations Unit Fully Remote - KY - Military Veterans
CVS Health
Remote
senior
special investigations
remote
military
veterans
fraud
health
healthcare
healthcare fraud
military
veterans
travel
prosecution
January 31, 2023
CVS Health
Kentucky
MILITARY VETERANS
The Special Investigative Unit (SIU) Senior Investigator must either be located in Kentucky or surrounding states and willing to travel to Kentucky multiple times a year.
Conducts investigations to effectively pursue the
prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.
Conducts investigations of known or suspected acts of
healthcare fraud and abuse
- Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases
- Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc.
Facilitates the recovery of company and customer money lost as a result of fraud matters
- Provides input regarding controls for monitoring fraud related issues within the business units
- Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company- Maintains open communication with constituents within and external to the company.
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in tracking system
Makes referrals and deconflictions, both internal and external, in the required timeframe
Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations
Exhibits behaviors outlined in Employee Competencies
Pay Range
The typical pay range for this role is:
Minimum:
43,700
Maximum:
100,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Minimum three years in healthcare field working in fraud, waste and abuse investigations and audits.
Strong analytical and research skills.
Proficient in researching information and identifying information resources.
Strong verbal and written communication skills.
Strong customer service skills.
Ability to interact with different groups of people at different levels and provide assistance on a timely basis.
Proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
Ability to utilize company systems to obtain relevant electronic documentation
Preferred Qualifications
Located in the Kentucky area. If not located in Kentucky, must be willing to travel to Kentucky.
Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI)
Billing and Coding certifications such as CPC (AAPC) and/or CCS (AHIMA)
Knowledge of CPT/HCPCS/ICD10 coding
Experience with Medicaid/Medicare
Experience with Behavioral Health
Knowledge of Aetna's Medicaid policies and procedures is a plus
Education
Bachelor's degree, or Associates' degree with additional three years of healthcare fraud investigation experience.
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
See
The Special Investigative Unit (SIU) Senior Investigator must either be located in Kentucky or surrounding states and willing to travel to Kentucky multiple times a year.
Conducts investigations to effectively pursue the
prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.
Conducts investigations of known or suspected acts of
healthcare fraud and abuse
- Communicates with federal, state, and local law enforcement agencies as appropriate in matters pertaining to the prosecution of specific healthcare fraud cases
- Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, customer members, etc.
Facilitates the recovery of company and customer money lost as a result of fraud matters
- Provides input regarding controls for monitoring fraud related issues within the business units
- Delivers educational programs designed to promote deterrence and detection of fraud and minimize losses to the company- Maintains open communication with constituents within and external to the company.
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
Researches and prepares cases for clinical and legal review.
Documents all appropriate case activity in tracking system
Makes referrals and deconflictions, both internal and external, in the required timeframe
Cost effectively manages use of outside resources and vendors to perform activities necessary for investigations
Exhibits behaviors outlined in Employee Competencies
Pay Range
The typical pay range for this role is:
Minimum:
43,700
Maximum:
100,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Minimum three years in healthcare field working in fraud, waste and abuse investigations and audits.
Strong analytical and research skills.
Proficient in researching information and identifying information resources.
Strong verbal and written communication skills.
Strong customer service skills.
Ability to interact with different groups of people at different levels and provide assistance on a timely basis.
Proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information.
Ability to utilize company systems to obtain relevant electronic documentation
Preferred Qualifications
Located in the Kentucky area. If not located in Kentucky, must be willing to travel to Kentucky.
Credentials such as a certification from the Association of Certified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI)
Billing and Coding certifications such as CPC (AAPC) and/or CCS (AHIMA)
Knowledge of CPT/HCPCS/ICD10 coding
Experience with Medicaid/Medicare
Experience with Behavioral Health
Knowledge of Aetna's Medicaid policies and procedures is a plus
Education
Bachelor's degree, or Associates' degree with additional three years of healthcare fraud investigation experience.
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
See
Report this job