Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Tallahassee, FL
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
4d
Insurance Verification Specialist
Tallahassee Memorial Healthcare —Tallahassee, FL
- Full-time
- Background check
- Surgery
- Hospital
4d
TELECOMMUNICATIONS SPECIALIST III - 72001508
The State of Florida —Tallahassee, FL
- $47,954.92 a year
- Overtime
- Background check
- Microsoft Excel
- Writing skills
Dental Billing Specialist
BOND COMMUNITY HEALTH CENTER INC. —Tallahassee, FL
- Full-time
- Computer literacy
- HIPAA
- Mid-level
Quick Apply
Professional Billing Specialist
Singing River Health System —Tallahassee, FL
- Weekends as needed
- Remote
- Microsoft Outlook
- Customer service
- 5 years
Quick Apply
Customer Relations Specialist
Suburban Propane —Tallahassee, FL
- Full-time
- Mid-level
- Residential
- 3 years
- Disability insurance
- Health insurance
Patient Access Associate Specialist
Ensemble Health Partners —Tallahassee, FL
- $17.00 - $18.15 an hour
- Part-time
- Hospital
- Customer service
- High school diploma or GED
- Tuition reimbursement
Lead Service Specialist
Opensity Solutions —Tallahassee, FL
- $22 - $25 an hour
- Full-time
- Ability to walk for extended periods
- Mid-level
- High school diploma or GED
Quick Apply
3d
Intake Specialist - Clinical Support
BOND COMMUNITY HEALTH CENTER INC. —Tallahassee, FL
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
Quick Apply
Member Services & Technology Support Specialist
Tallahassee Board of Realtors®/Capital Area Technology & Realtor® Services —Tallahassee, FL
- $46,000 - $56,000 a year
- Full-time
- Background check
- English
- Office
- Disability insurance
- Health insurance
Quick Apply
13d
Patient Access Associate Specialist
Ensemble RCM LLC —Tallahassee, FL
- $17.00 - $18.15 an hour
- Full-time
- Hospital
- Customer service
- High school diploma or GED
- Tuition reimbursement
11d
Physician Practice E&M Auditor Educator, Medical Group Auditing & Coding, FT,8A-4:30P (Hybrid)
Baptist Health South Florida —Florida
- $26.13 - $33.97 an hour
- Full-time
- Hybrid work
- Customer service
- Research
- Mid-level
- Wellness program
- Health insurance
Mental Health Therapist - Florida
NOCD —Florida
- Weekends as needed
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Paid parental leave
- Health insurance
Quick Apply
OPS REGULATORY SPECIALIST II - 64802046
The State of Florida —Tallahassee, FL
- $16.50 an hour
- Temporary
- Background check
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Dental insurance
3d
Front Desk Associate
United Spine & Pain —Tallahassee, FL
- From $15 an hour
- Full-time
- Background check
- Private practice
- HIPAA
- Health insurance
- Paid time off
Quick Apply
Remote Registered Dietitian or CNS - Flexible Hours, Work from Anywhere
Berry Street —Tallahassee, FL
- Up to $85 an hour
- Choose your own hours
- Remote
- Mid-level
- Marketing
- Commercial
- Health insurance
- Flexible schedule
Quick Apply
6d
Tax Manager - Real Estate
Deloitte —Tallahassee, FL
- $100,350 - $205,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Finance
Tax Manager - Federal / Corporate Tax
Deloitte —Tallahassee, FL
- $100,350 - $205,000 a year
- Full-time
- Hybrid work
- CPA
- 5 years
- Writing skills
Patient Access Specialist FT
Ensemble RCM LLC —Tallahassee, FL
- $17.00 - $18.15 an hour
- Full-time
- Hospital
- Customer service
- High school diploma or GED
- Tuition reimbursement
Customer Support Specialist (Seasonal)
Greenix Pest Control —Tallahassee, FL
- From $15 an hour
- Full-time
- Remote
- Computer literacy
- High school diploma or GED
- Computer skills
- Paid training
- Paid holidays
Quick Apply

I want to receive the latest job alert for professional billing specialist in tallahassee, fl

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

professional billing specialist jobs near tallahassee, fl

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Tallahassee, FL

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
4 days 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

professional billing specialist jobs in tallahassee, fl

Fraud and Abuse Investigator / CPC - Remote

Insurance Verification Specialist

TELECOMMUNICATIONS SPECIALIST III - 72001508

Dental Billing Specialist

Professional Billing Specialist

Customer Relations Specialist

Patient Access Associate Specialist

Lead Service Specialist

Intake Specialist - Clinical Support

Member Services & Technology Support Specialist

Patient Access Associate Specialist

Physician Practice E&M Auditor Educator, Medical Group Auditing & Coding, FT,8A-4:30P (Hybrid)

Mental Health Therapist - Florida

OPS REGULATORY SPECIALIST II - 64802046

Front Desk Associate

Remote Registered Dietitian or CNS - Flexible Hours, Work from Anywhere

Tax Manager - Real Estate

Tax Manager - Federal / Corporate Tax

Patient Access Specialist FT

Customer Support Specialist (Seasonal)

I want to receive the latest job alert for professional billing specialist in tallahassee, fl

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