Investigator External Audit Special Investigations Unit *Remote

The SIU Audit Investigator supports the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan.

• Identification, investigation and correction of fraudulent and/or abusive billing and coding practices
• Coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices
• Providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities

• Bachelor's degree or equivalent combination of education and experience
• 5 years coding experience with a healthcare provider, facility or health insurance company
• 2 years Fraud and Abuse audit experience in a health insurance company, healthcare provider, facility or other relevant healthcare environment
• Project management experience, education program development experience and group presentation experience
• Experience in use of data mining software/tools

• 401k matching
• Health insurance
• Flight privileges

Providence Health Plan is a comprehensive health care organization that serves more people, advances best practices and continues our more than 100-year tradition of serving the poor and vulnerable.