Top 8 Fraud analyst remote Jobs in Chandler Az

ABA Clinical Reviewer
TriWest Healthcare Alliance —Phoenix, AZ
- $79,000 - $93,000 a year
- Full-time
- Microsoft Outlook
- Customer service
- Computer literacy
- AD&D insurance
- Disability insurance
11d
Human Resources Analyst Senior
State of Arizona —Phoenix, AZ
- $55,000 - $62,000 a year
- Full-time
- OSHA
- Writing skills
- Research
- Paid parental leave
- Paid holidays
Manager, Network Recruitment
Oscar Health —Tempe, AZ
- $100,602 - $132,040 a year
- Remote
- 3 years
- Bachelor's degree
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Assistant Chief Financial Examiner
State of Arizona —Phoenix, AZ
- Up to $98,000 a year
- Full-time
- Microsoft Outlook
- CPA
- Word processing
- Paid parental leave
- Disability insurance
11d
Senior Credit Risk Analyst
VANTAGE CARD SERVICES INC —United States
- Full-time
- 5 years
- Residential
- Bachelor's degree
- Health savings account
- AD&D insurance
Quick Apply
2d

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ABA Clinical Reviewer

TriWest Healthcare Alliance -
Phoenix, AZ

Apply Now

Job Details

Full-time
$79,000 - $93,000 a year
11 days ago

Benefits

AD&D insurance
Disability insurance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Medical documentation
Electronic health records (EHR) management
Behavior analysis
Patient care
Board Certified Behavior Analyst
Healthcare treatment

Full Job Description

Profile

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Applies clinical criteria and knowledge for medical necessity determinations for Applied Behavior Analysis (ABA) services to ensure adherence to contract benefits and requirements. Reviews treatment plans and outcome measures submitted by ABA providers for compliance with benefit requirements. Prepares and presents more complex cases for Medical Director review. Advises non-clinical staff on clinical coding questions. This position reports to the Director, Case Management Programs.

Education & Experience

Required:

Board Certified Behavior Analyst (BCBA)
U.S. Citizenship
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
At least 3 years’ experience of direct clinical care to the consumer
Demonstrated experience working with electronic medical record applications

Preferred:

One (1) year managed care experience
Experience with TRICARE ABA service delivery and requirements

Key Responsibilities

Conducts prior authorization activities and referral management activities
Assesses medical necessity by screening available information against established criteria, using InterQual® clinical guidelines and other clinical decision support tools
Interprets information submitted by providers for completeness and compliance
Ensures timely reviews and appropriate notification to interested parties
Contact providers to obtain or clarify clinical information as necessary
Prepares cases for Medical Director and Peer Review according to established policy
Participates in quality monitoring activities as part of a team
Participates in the review of clinical decision support tools and provider education materials to ensure applicability and best practice
Makes appropriate referrals to Program Integrity when fraud, waste, and abuse is suspected
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles and diverse points of view; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position. Respectful behavior while working with a diverse population.

Independent Thinking / Self-Initiative: Critical thinker with the ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues and clinical practice.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Respectful behavior amongst a diverse workforce.

Technical Skills: Expert knowledge of ABA services and delivery models. General knowledge of TRICARE or other government health care programs; Knowledge in the application of clinical criteria: InterQual, ICD-10-CM, DSM, and CPT coding; Proficient with Microsoft Office

Working Conditions

Working Conditions:

Ability to cover any work shift
Onsite: Works within a standard office environment
Remote: Private and secure workspace and work station with high speed internet is required.
Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

Medical, Dental and Vision Coverage
Paid time off
401(k) Retirement Savings Plan (with matching)
Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
Tuition reimbursement
Paid volunteer time

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $79,000 - $93,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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fraud analyst remote jobs in chandler az

ABA Clinical Reviewer

Human Resources Analyst Senior

Manager, Network Recruitment

Assistant Chief Financial Examiner

Senior Credit Risk Analyst

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