[Remote] Senior Investigator (Healthcare FWA) Provider Escalations

Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on healthcare analytics and fraud prevention. As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse, primarily supporting provider escalations related to prepayment FWA services. Responsibilities • Act as the primary contact for escalated provider-related concerns related to Cotiviti’s prepayment FWA service, ensuring timely and thorough resolution • Educate providers regarding Cotiviti claim determinations including review of coding and payment guidelines, plan policy, and other relevant sources • Partner with Cotiviti clients and internal client services staff to resolve provider complaints, schedule educational calls, disseminate relevant reporting and recommend subsequent investigative steps • Document and report detailed records of escalations, investigations, and outcomes. Prepare reports for internal and external use • Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse • Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review • Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation • Conducts investigation-related training • Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions • Negotiates settlement agreements to resolve disputes • Maintain current knowledge of relevant laws, regulations and standards • Participates in special projects as required Skills • Bachelor's Degree in related discipline, or the equivalent combination of education, professional training and work experience • 5-8 years of related investigative experience • Experience in proactive data mining • Experience in sampling and data extrapolation; prior use with RAT-STATS preferred • Advanced level skills in Excel • Excellent verbal and written communication skills • Strong listening and observation skills • Attention to detail and high level of accuracy • Effective organizational and prioritization skills with multi-tasking ability • Required certifications: Certified Professional Coder (CPC) • Experience with Cotiviti's FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions) • Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC) Benefits • Medical • Dental • Vision • Disability • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti Company Overview • Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is Apply tot his job