PLEASE NOTE BEFORE APPLYING: This person MUST come from the HEALTHCARE SPACE performing Fraud Investigations within Healthcare. This is non-negotiable
Do you want to help make healthcare more effective and affordable for everyone? That’s our mission at Codoxo. The U.S. spends more on healthcare than any other country in the world, but not all of the $3.8 trillion goes to real patient care. A significant portion, up to 10% or $380 billion, is lost to fraud, waste, and abuse.
Codoxo’s patented artificial intelligence technology helps healthcare companies and agencies identify and act quickly to control costs. Codoxo now has six AI-powered applications that help every department across health insurance payers proactively bring down costs and reduce fraud, waste, and abuse – so more dollars to toward patient care.
Primary Responsibilities:
- Perform data analytics to identify fraud, waste or abuse in claims data
- Responsible for investigating, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices.
- Proactively identify instances of potential fraud, waste and abuse through data analysis using company system and tool
- Prepare statistical/financial analysis reports and graphic presentation for notification of findings
- Use knowledge of heath care coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies and relevant laws to find suspicious patterns in claims data and other sources
- Develop and maintain general knowledge healthcare reimbursement policies and state and federal regulations related to healthcare fraud and abuse
- Work cooperatively and constructively with team members, including mentoring, training and assisting team members as required
- Perform additional duties and projects as assigned by management
- Maintain security and confidentiality of all protected health information encountered in performance of duties
Required Qualifications:
- 1+ years of experience working in a healthcare Fraud Investigations role
- 1+ years of experience within the Health Insurance Claims Industry
Preferred Qualifications:
- Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar