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Special Investigations Unit Coordinator
RENO NV 89505
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-88399031

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Renown Health

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Summary

  Job posted:   Tue Apr 17, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Special Investigations Unit Coordinator
Special Investigations Unit Coordinator

Requisition id: 138401


Department: 500701 Administration


Facility: Hometown Health


Schedule: Full Time - Eligible for Benefits


Shift: Day


Category: Professional


Location: Reno, NV


Position Purpose: The SIU Coordinator conducts healthcare fraud and abuse investigations as a member of the Special Investigations unit within the Performance department. Position will also evaluate the adequacy and effectiveness of internal control, risk management, and governance processes for Hometown Health and Medicare Advantage products. Nature and Scope: Manages large caseloads and investigates allegations and issues pertaining to potential health care fraud by providers or members. Documents investigations, including preliminary and final case reports, for both internal tracking and regulatory reporting purposes.


Proactively identifies trends and aberrant activity to generate leads for fraud investigations and analyzes claims data to detect fraudulent activity. Performs operational and Fraud, Waste, and Abuse audits; special projects, as requested; and internal control and information systems evaluations at the direction of the Chief Operating Officer, Director and/or Senior SIU Coordinator.


This position must be objective and independent of the activity being reviewed. It is authorized to have free and unrestricted access to organization functions, records, property, and personnel.


Knowledge, Skills and Abilities: The ability to communicate in a way that clearly conveys project objectives, evaluations, conclusions, and recommendations. The ability to maintain satisfactory relationships with project clients. The ability to apply knowledge to recognize the existence of problems or potential problems and identify additional research to be undertaken or assistance to be obtained in the following areas: * Internal audit standards, procedures, and techniques * Management principles and deviations from good business practices * Fundamentals of business subjects.


This position doesn't provide direct patient care. The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications: Requirements - Required and/or Preferred Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Requires B.S. or B.A. in a related field or equivalent combination of education and experience. Experience: Health care fraud-related investigations, auditing, and/or Pharmacy PBM claims experience. License(s): None. Certification(s): Professional designation preferred. Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Essential Physical Requirements






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