Job Description
The Senior Investigator supports the Program Integrity Manager and department investigators. This role assists with developing, implementing, and performing fraud, waste, and abuse related auditing and monitoring activities. This includes the identification, investigation and correction of fraudulent, wasteful, and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements. The Senior Investigator must develop excellent professional relationships with internal and external partners and providers and their representatives, other payers, regulatory agencies, local healthcare law enforcement and accrediting bodies.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing medical group.