Fraud and Abuse Investigator / CPC - Remote
Sentara Workforce Solutions, LLC —Bangor, ME
- $25.60 - $42.67 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- 2 years
- 403(b) matching
- Paid parental leave
Quick Apply
2d
Technical Sanitation Specialist (Hybrid/Regional Travel)
HP Hood —Portland, ME
- $75,000 - $93,000 a year
- Hybrid work
- 5 years
- Bachelor of Science
- Mid-level
- Relocation assistance
- Health insurance
2027 Audit Staff
Baker Newman Noyes LLC —Portland, ME
- $62,521 - $93,833 a year
- Full-time
- Hybrid work
- Travel
- Communication skills
- Entry level
- Profit sharing
- Paid parental leave
Quick Apply
Senior Compliance Investigator
Centene —Maine
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
12d
Shift Inspector (RII)
C&L Aviation Group —Bangor, ME
- $34 an hour
- Full-time
- 5 years
- Military
- Ability to lift 50 pounds
- Health savings account
- Relocation assistance
Quick Apply
Plant Controller
Walpole Outdoors LLC —Pittsfield, ME
- Bachelor of Science
- 3 years
- Bachelor's degree
Quick Apply
Electric Billing Clerk
Houlton Water Company —Houlton, ME
- $24 - $28 an hour
- Full-time
- Background check
- Office
- Finance
- Disability insurance
- Health insurance
Quick Apply
3d
Cost Estimator - Senior
Fiber Materials —Biddeford, ME
- $80,000 - $120,000 a year
- Microsoft Outlook
- Office
- Finance
- Paid holidays
- Health insurance
Commercial Loan Underwriter
New Dimensions Federal Credit Union —Waterville, ME
- $27.72 - $41.57 an hour
- Full-time
- Background check
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
Quality Manager
Lepage Bakeries Cedar St, LLC —Lewiston, ME
- $83,000 - $93,000 a year
- Full-time
- 5 years
- Bachelor of Science
- Supervising experience
- Paid training
- Paid holidays
Experienced Tax Professional--Multiple Openings--
H&R Block —Portland, ME
- Temporary
- Background check
- CPA
- Sales
- Employee stock purchase plan
- Health insurance
Quick Apply
2d
Accounting & Advisory Associate
Skillcloud HCM —Yarmouth, ME
- $75,000 - $90,000 a year
- Full-time
- Hybrid work
- CPA
- Mid-level
- Office
- Paid holidays
- Disability insurance
Quick Apply
Chief Aircraft Inspector
MAC Air Group —South Portland, ME
- $75,000 - $100,000 a year
- Full-time
- Senior level
- Health savings account
- AD&D insurance
Quick Apply
Records Management Specialist
Assistance Plus —Benton, ME
- $20 - $22 an hour
- Full-time
- 18 years or older
- HIPAA
- Office
- Paid holidays
- Disability insurance
Clinical Support Specialist
Spurwink Services —Randolph, ME
- $18.35 - $20.19 an hour
- Full-time
- Clean driving record
- Customer service
- Mid-level
- Paid training
- Disability insurance
12d
Staff Accountant
Maine Technology Institute —Portland, ME
- $70,000 - $85,000 a year
- Full-time
- Hybrid work
- Background check
- Mid-level
- Office
- Disability insurance
- Health insurance
Quick Apply
Experienced Tax Professional--Multiple Openings--
H&R Block —Biddeford, ME
- Temporary
- CPA
- Sales
- 5 years
- Employee stock purchase plan
- Health insurance
Quick Apply
Staff Accountant
R.C. Moore, Inc. —Portland, ME
- $50,000 - $75,000 a year
- Full-time
- Background check
- Research
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
8d
Quality Manager
Skillcloud HCM —Oxford, ME
- $93,000 - $150,000 a year
- 8 hour shift
- 5 years
- Engineering
- ERP systems
- Paid holidays
- Disability insurance
Quick Apply
Cost Accountant
STARC Systems Inc —Brunswick, ME
- $85,000 - $105,000 a year
- Hybrid work
- ERP systems
- Mid-level
- 3 years
- Health savings account
- AD&D insurance
Quick Apply

I want to receive the latest job alert for audit in maine

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

Fraud and Abuse Investigator / CPC - Remote

Sentara Workforce Solutions, LLC
Bangor, ME

Quick Apply

Job Details

Full-time
$25.60 - $42.67 an hour
2 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

audit jobs in maine

Fraud and Abuse Investigator / CPC - Remote

Technical Sanitation Specialist (Hybrid/Regional Travel)

2027 Audit Staff

Senior Compliance Investigator

Shift Inspector (RII)

Plant Controller

Electric Billing Clerk

Cost Estimator - Senior

Commercial Loan Underwriter

Quality Manager

Experienced Tax Professional--Multiple Openings--

Accounting & Advisory Associate

Chief Aircraft Inspector

Records Management Specialist

Clinical Support Specialist

Staff Accountant

Experienced Tax Professional--Multiple Openings--

Staff Accountant

Quality Manager

Cost Accountant

I want to receive the latest job alert for audit in maine

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