Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Columbus, OH
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
1d
Classroom Intervention Aide/Substitute Classroom Intervention Aide (SY 26-27)
Columbus City Schools —Columbus, OH
- $23.37 an hour
- Seasonal
- Classroom
- High school diploma or GED
- 21 years or older
6d
WA2 Mech Stockhandler
JCPenney —Columbus, OH
- $20.50 - $25.75 an hour
- Basic math
- Forklift
- Entry level
- Paid holidays
- Health insurance
Warehouse Worker - Full-Time Shifts
McKesson —Columbus, OH
- $20.00 - $22.92 an hour
- Full-time
- Ability to walk for extended periods
- Ability to lift 50 pounds
- Driving
- Wellness program
- Employee stock purchase plan
ProSales Associate Black and Gold Academy US
Herc Rentals —Columbus, OH
- $28.85 an hour
- Full-time
- Driver's License
- Travel
- Associate's degree
- Paid parental leave
- Health savings account
Part-Time Nanny Needed
Ohio Nanny Family Collective —Carroll, OH
- $25 - $40 an hour
- Part-time
- Background check
- CPR Certification
- Associate's degree
- Paid time off
- Flexible schedule
Quick Apply
Peer Recovery Specialist
Lutheran Social Services of Central Ohio —Columbus, OH
- $19 - $21 an hour
- Full-time
- CPR Certification
- Addiction Medicine
- BLS Certification
- Health savings account
- Paid holidays
Quick Apply
1d
Associate Recruiter
Mix Talent LLC —Columbus, OH
- Sales
- Bachelor's degree
- Organizational skills
Order Filler Picker
DHL —Lockbourne, OH
- $17.75 an hour
- Full-time
- Customer service
- High school diploma or GED
- Warehouse experience
- Paid holidays
- Health insurance
Quick Apply
7d
Production Technician, Launch Team
Anduril Industries —Columbus, OH
- $23.00 - $31.50 an hour
- Overtime
- Word processing
- Computer literacy
- Writing skills
Quick Apply
Logistics Associate
Carvana —Columbus, OH
- $15 - $17 an hour
- 18 years or older
- Clean driving record
- High school diploma or GED
- Health insurance
- Dental insurance
2d
Local CDL A Truck Driver
Continental Express Inc. —Columbus, OH
- $25.50 - $29.50 an hour
- Night shift
- Local
- CDL A
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Collection Specialist
Phillips & Cohen Associates Ltd. —Gahanna, OH
- From $20 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- High school diploma or GED
- Analysis skills
- Free parking
- Health insurance
Quick Apply
Product Promoter
MSI —Columbus, OH
- $50,000 - $65,000 a year
- Weekends as needed
- Microsoft Outlook
- Up to 50% travel
- Merchandising
- Disability insurance
- Health insurance
9d
Meta Retail Specialist
Channel Partners —Reynoldsburg, OH
- $18.50 an hour
- Overtime
- Customer service
- Writing skills
- Merchandising
- Paid training
- 401(k)
CDL-A - New pay increase - Tanker truck driver
Schneider —Obetz, OH
- Up to $0.04 per mile
- Weekends as needed
- Hazmat Endorsement
- CDL A
- Mid-level
- Paid holidays
- Health insurance
Material Expeditor
Strategic Staffing Solutions —Columbus, OH
- $45,000 - $55,000 a year
- 8 hour shift
- Mid-level
- Office
- 3 years
- Health insurance
- Dental insurance
Quick Apply
3d
Late Night (4pm to 12am) Team Member - Otterbein University (Nights and Weekends)
Otterbein Dining —Westerville, OH
- $17 - $21 an hour
- 8 hour shift
- Background check
- Serving
- Hospitality
- Paid training
- Disability insurance
Quick Apply
Warehouse Associate Backup Driver 5am-2pm
K&M Tire —Columbus, OH
- $18 - $20 an hour
- Full-time
- Forklift
- Driver's License
- No degree
- Profit sharing
- Health insurance
Quick Apply
CDL-A - Intermodal truck driver
Schneider —Columbus, OH
- $1,390 - $1,700 a week
- Full-time
- Hazmat Endorsement
- No touch freight
- CDL A
- Paid holidays
- Health insurance

I want to receive the latest job alert for associate 12 month in columbus

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

associate 12 month jobs near columbus

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Columbus, OH

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
1 day ago

Benefits

403(b) matching
Paid parental leave
Caregiver leave
Disability insurance
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
403(b)
Life insurance
Pet insurance

Qualifications

Statistics
Healthcare financial misconduct investigations
Investigations regulatory compliance
Regulatory compliance in claims processing
Mid-level
Internal investigations
Certified Professional Coder
Quality assurance audits
Insurance investigation report preparation
Retrospective medical coding audits
Bachelor's degree
Health insurance knowledge
Healthcare billing investigations
Settlement negotiation
Quality audits
Insurance claims auditing
Healthcare claims compliance audits
Research findings presentation
2 years
Healthcare compliance
Documentation review

Full Job Description

City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

Sentara Health Plan is currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote!

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm EST, M-F

Location: This position is remote for candidates that live in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming; With travel to Virginia Beach 1x a year.

Job Summary:

Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products through Sentara Health Plans lines of business. Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital-based coding in routine desk audits as well as occasional on-site audits. Contributes to the review of reimbursement systems relating to health insurance claims processing and ensures adherence to health plan policies and procedures for its various product offerings.

Job Description:

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.
Learn and conduct statistical sampling of complex medical claims.
Assists in drafting settlements

Education:

Bachelor's degree preferred

Certifications/Licenses:

Certified Professional Coder preferred (or achieved within 12 months of hire date)

Experience:

2 years combined experience required in Internal/External Audit OR regulatory/Compliance OR Healthcare preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $25.60/hour- $42.67/hour. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-102996

Talroo-Health Plan

Keywords: Healthcare, Health Plan, Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming, Bachelor's Degree, Medical Coding, Medical Chart Review, Insurance Billing, Internal/External Audit, Regulatory, Compliance, Claims Investigations, Criminal Investigation, White Collar Crime, Certified Professional Coder (CPC), Fraud, Waste, Abuse, Program Integrity, FWA, PI, SIU, Special Investigations Unit

Benefits: Caring For Your Family and Your Career

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Quick Apply

Refine Your Search

associate 12 month jobs in columbus

Fraud and Abuse Investigator / CPC - Remote

Classroom Intervention Aide/Substitute Classroom Intervention Aide (SY 26-27)

WA2 Mech Stockhandler

Warehouse Worker - Full-Time Shifts

ProSales Associate Black and Gold Academy US

Part-Time Nanny Needed

Peer Recovery Specialist

Associate Recruiter

Order Filler Picker

Production Technician, Launch Team

Logistics Associate

Local CDL A Truck Driver

Collection Specialist

Product Promoter

Meta Retail Specialist

CDL-A - New pay increase - Tanker truck driver

Material Expeditor

Late Night (4pm to 12am) Team Member - Otterbein University (Nights and Weekends)

Warehouse Associate Backup Driver 5am-2pm

CDL-A - Intermodal truck driver

I want to receive the latest job alert for associate 12 month in columbus

Related Searches

Explore jobs in more locations

Sentara Health Plan is currently hiring a Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote!

Job Seeker Tools

Employer Tools

Browse

Stay Connected