Coding Investigative Analyst/Auditor (Remote Opportunity)
VetsEZ (Veterans EZ Info, Inc.), a verified Service-Disabled Veteran-Owned Small Business (SDVOSB), is a leading provider of information technology services to commercial and government markets. VetsEZ is a company of Subject Matter Experts with deep expertise in Healthcare IT and Benefits Delivery. VetsEZ strongly believes in making complexity EZ by providing tangible solutions that improve day-to-day business transactions, maximize efficiencies, eliminate risks, and reduce costs for our clients. For more information, visit us at www.vetsez.com. We are seeking a Coding Investigative Analyst/Auditor to be a part of a remote team. The candidate must reside within the continental US. Responsibilities:
- Collaborate with Investigators to validate claims of Fraud, Waste, and Abuse
- Identify trends of fraud, waste, and abuse and evaluate cases for indicators
- Monitor predictive analytics tool to identify schemes and trends within the data universe.
- Evaluate and customize rules to reduce false positives, as needed
- Extract and research duplicate detection report to identify wrongfully paid claims
- Conduct coding, standards of practice, and policy reviews
- Assess investigative findings and/or other case related data to determine patterns of potential fraud, waste, and abuse
- Accurately make claim coverage determinations based on applicable policies, payment rules, coding guidelines, and CMS Local Coverage Determinations Requirements:
- Bachelor’s degree in Information Technology, Computer Science, or any equivalent discipline is required
- A minimum of 3 years of experience in FWA in Federal space
- 3-5 years of experience in the health care industry
- 2+ years of experience conducting or managing comprehensive research
- Proficiency using Microsoft Word, Excel, and Outlook
- Ability to work well in a remote team environment, to collaborate with others, and interface with team members internal and external to the organization.
- 3+ years of health care data analysis and interpretation
- Coding certification – Facility and Professional Additional Qualifications:
- Ability to communicate clearly and professionally with all levels of the organization, both written and verbal
- Flexibility and ability to plan, prioritize, and execute multiple tasks in a fluid environment
- Self-motivated, well-organized, and detail oriented
- Ability to maintain a high level of confidentiality and integrity
- Experience working in Federal Contracts
- Ability to evaluate State and Federal regulations/guidelines
- Proficiency in research, interpretation, and application of healthcare regulations and policies
- Ability to perform well in team environment, with staff at all levels, to achieve business goals.
- Ability to work independently to meet predefined production and quality standards
- A basic level of knowledge of health care data analysis, claims processing and auditing
- Ability to obtain a government clearance Benefits:
- Medical/Dental/Vision
- 401k with Employer Match
- PTO + Federal Holidays
- Corporate Laptop
- Training opportunities
- Remote Opportunity Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or protected veteran status. Sorry, we are unable to offer sponsorship at this time Apply tot his job
Apply tot his job Apply To this Job