Remote Medical Fraud Investigator

Piper Companies - Towson, MD4.0

Full-time$75,000 a year
Piper Clinical Solutions is looking for a motivated Remote Medical Fraud Investigator to support a fraud, waste, and abuse Special Investigations Unit with review and investigations of medical documentation and claims to identify and investigate suspected incidents of fraud, waste or abuse.

Responsibilities for the Remote Medical Fraud Investigator:
Identify potential instances of fraud, waste, and abuse (FWA) through the investigation and analysis of provider documentation, claims, data and other resources Spoke
Conduct interviews and correspond with patients, providers, witnesses and other related parties to determine corrective actions such as settlement, denial, or review
Analyze information and data gathered through investigations
Utilize data analysis tools and software to analyze and gather pertinent data and information
Develop written formal summaries and presentations based on findings and recommendations
Support any legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare identified fraudulent cases for civil or criminal actions
Negotiate settlement agreements with providers and insurance companies to resolve disputes

Requirements for the Remote Medical Fraud Investigator:
4+ years of medical FWA investigation experience
Expert knowledge of Excel data analysis tools and other relevant data analysis software
Ability to write formal reports and communicate effectively
Active Fraud Certification highly preferred (CFS, CFE, CPC, CFI, CHC, or AHFI)
Bachelor’s Degree in related field or Associates Degree with additional professional experience

Compensation for the Remote Medical Fraud Investigator:
Salary up to $75,000 based on meeting of requirements
Benefits: Health, Dental, & Vision Insurance, 401K

Please send all qualified resumes to: