Related skills
data analytics icd cpt hcpcs medicare📋 Description
- Analyze suspected fraud, waste, and abuse per regulations and policies
- Conduct investigations to prevent/detect issues using data analytics
- Review all claim documentation for integrity and regulatory compliance
- Collaborate with internal stakeholders on findings and remediation
- Educate external providers on proper billing practices
🎯 Requirements
- High school diploma required; bachelor’s degree preferred
- Minimum 4 years in healthcare with fraud, waste, and abuse investigations
- Strong knowledge of PACE, managed care, Medi-Cal and Medicare
- Knowledge of federal/state guidelines and ICD, CPT, HCPCS coding
- Experience using data analytics to identify billing anomalies
🎁 Benefits
- Medical insurance coverage (Medical, Dental, Vision)
- PTO: 17 personal days, 12 holidays, 6 sick days
- 401K with match
- Comprehensive compensation package including base pay and bonus
- Additional employee benefits
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