Elevance Health • Seattle, WA 98194
Job #2680931592
WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.
Clinical Fraud Investigator II
Job Family: FRD > Investigation
Type: Full time
Date Posted:Apr 23, 2024
Anticipated End Date:Apr 30, 2024
Reference: JR111691
Location:
GA, ATLANTA
CA, WOODLAND HILLS
WI, Waukesha
IN, INDIANAPOLIS
IA, DES MOINES
OH, CINCINNATI
NY, NEW YORK
KY, LOUISVILLE
WA, SEATTLE
NH, MANCHESTER
FL, MIAMI
TX, GRAND PRAIRIE
NV, LAS VEGAS
IL, CHICAGO
TN, NASHVILLE
LA, METAIRIE
NE, LINCOLN
GA, COLUMBUS
DC, WASHINGTON
MN, MENDOTA HEIGHTS
VA, NORFOLK
CT, WALLINGFORD
MO, ST LOUIS
MD, HANOVER
WV, CHARLESTON
NJ, ISELIN
DE, WILMINGTON
CO, DENVER
CA, PALO ALTO
NC, WINSTON
ME, SOUTH PORTLAND
NY, LATHAM
VA, RICHMOND
TX, HOUSTON
RI, Providence
Description
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Hybrid Workplace Strategy: 1-2 days in office per week
The Clinical Fraid Investigator II is responsible for identifying issues and/or entities that may pose potential risk associated with fraud and abuse.
How you will make an impact:
Conducts data mining activities using available tools and internal data warehouse.
Performs comprehensive analysis and clinical evaluation of the collected data.
Performs in-depth investigations on identified providers as warranted.
Examines claims for compliance with relevant billing and processing guidelines and to identify opportunities for fraud and abuse prevention and control.
Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare related questions as necessary to aid in investigations.
Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.
Recommends possible interventions for loss control and risk avoidance based on the outcome of the investigation.
Minimum Requirements:
Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 years related experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or any combination of education and experience, which would provide an equivalent background.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $66,800 to $120,240
Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ~~~ for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
EEO Policy Statement
Know Your Rights
Pay Transparency
Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer (~~~)
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