Presbyterian Health Solutions.

  • Albuquerque, NM


  • Irreversible.

  • Full-time.

HEALTH CARE SCAMS MEDICAL CODING DETECTIVE – REMOTE ELIGIBLE

Appropriation ID 2020-16930 Classification Legal/Compliance Default: Area: City Albuquerque Area: Call 9521 San Mateo NE Albuquerque, NM 87113-2237 Default: Place: State/Province (Complete Name) New Mexico

Summary

Task Description

Kind Of Chance: Full-time

FTE: 1.000000

Exempt: Yes

Work Set Up: Weekday Arrange Monday-Friday

This chance is open to remote candidates in the United States, with the exception of the following states:

Washington, Wyoming, North Dakota, and Ohio. Should have the ability to work mountain time.

Summary:

The SIU Private investigator supports the compliance associated activities of the Program Stability Department. Accountable for carrying out skilled evaluations into presumed scams, waste, or abuse with regard to supplier, drug store, company, member, and broker interactions including the complete series of items at Presbyterian. This consists of the recognition, examination, and correction of deceptive, inefficient, and/or violent billing and coding practices; coordination of healing of overpayments connected to deceitful and/or violent billing and coding practices; and offering education associated to coding/representation of services and suitable medical record paperwork requirements. The perfect prospect must have competent experience in claims scams, waste and abuse examination.

Duties

Duties:

Skilled level of:

  • Investigational experience
  • Procedural coding
  • Technical composing abilities
  • Analytical abilities
  • Capability to find out
  • Important thinking and attention to information

Skilled interaction:

  • Helping with conferences
  • Authoring posts & letter members & service providers
  • Engaging with all levels of personnel and management within the company, committee members, management, in addition to the general public
  • Shown capability to interact efficiently personally and by means of telephone with members, company groups, doctors, and doctor workplace personnel utilizing strong discussion and client service proficiencies

Skilled interaction:

  • Handling disputes
  • Working out with suppliers

Intermediate level of:

  • Compliance with specifics to Health care accreditation and CMS.
  • Managed Care and awareness business operations, functions & procedures.

Competent utilizing:

  • MS Workplace
  • Adobe Pro
  • Web
  • Skype
  • In partnership with Senior Detective and Supervisor, handles the total instructions, coordination, execution, execution, and conclusion of appointed examinations making sure consistency with department technique, dedications, and objectives.
  • Might be accountable for concurrent and/or retrospective evaluation, information abstraction, analysis, recognition of vital concerns, procedure enhancement assistance, needed education, and helping with measurement of efficiency metrics.
  • Functions as resource advising procedure adjustments and practice modifications to enhance effectiveness, efficiency, and dependability of procedures and systems.
  • Builds and establishes collective relationships important to the success of cases and department.
  • Performs innovative scams, waste and abuse audits in accordance with compliance and audit work-plan and prepare comprehensive audit reports for management, legal counsel, and service providers.
  • Determines, examines, and deals with billing and coding associated queries and grievances from recipients, members, regulative firms and internal and external clients through recoupment of overpayments and education to suppliers

B

Certifications

Education Required

  • Associates degree and 3 years associated experience needed. 3 years of extra experience can be replaced in lieu of degree.
  • CPC or comparable needed
  • Licensed Scams Inspector (CFE) or Accredited Healthcare Scams Private Investigator (AHFI) chosen

Advantages

Advantages work day-one (for.45 FTE and above) and consist of:

  • Competitive wages
  • Complete medical, oral and vision insurance coverage
  • Versatile costs accounts (FSAs)
  • Free health cares
  • Paid time off (PTO)
  • Retirement strategies, consisting of matching company contributions
  • Continuing education and profession advancement chances
  • Life insurance coverage and short/long term special needs programs

About United States

Presbyterian Health Care Solutions is an in your area owned, not-for-profit health care system of 9 health centers, a statewide health insurance and a growing multi-specialty medical group. Established in New Mexico in 1908, it is the state’s biggest personal company with around 11,000 staff members.

Presbyterian’s story is truly the story of the exceptional individuals who have actually selected to work here. Beginning with Reverend Cooper who started our journey in 1908, the effort of countless doctors, staff members, board members, and other volunteers brought Presbyterian from a small tuberculosis insane asylum to a statewide health care system, serving more than 700,000 New Mexicans.

We belong to New Mexico’s history – and devoted to its future. That is why we will continue to work simply as tough and care simply as deeply to serve New Mexico for several years to come.

About New Mexico

New Mexico’s special mix of Spanish, Mexican and Native American impacts add to a culturally abundant way of life. Include Albuquerque’s International Balloon Carnival, Los Alamos’ nuclear researchers, Roswell’s visitors from deep space, and Santa Fe’s artists, and you get a diverse mix of individuals, locations and experiences that make this state fantastic.

Cities in New Mexico are constantly ranked amongst the country’s finest locations to work and live by Forbes publication, Kiplinger’s Personal Financing, and other business and federal government moving supervisors like Worldwide ERC.

New Mexico provides limitless leisure chances to check out, and take pleasure in an active way of life. Endeavor off the beaten course, challenge your body in the aspects, or open yourself approximately the extensive sky. From treking, playing golf and cycling to snowboarding, snowboarding and boating, it’s all offered amongst our gorgeous marvels of the west.

AA/EOE/VET/ DISABLED. PHS is a drug-free and tobacco-free company with smoke complimentary schools.

/.

Presbyterian Health Providers.

  • Apply Now.