Job Description
The Senior Investigator is responsible for supporting the Program Integrity Manager and department investigators. Duties include assisting with developing, implementing fraud, waste, and abuse related auditing and monitoring activities. Responsibilities also include 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 ideal candidate should have advanced experience in claims fraud, waste and abuse investigation. Must also analyzes and interprets medical records pertaining to fraud, waste, and abuse investigations and helps to determines appropriateness of billing and reimbursement.
About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health.