Top 52 Field investigator Jobs in Tampa, Fl

Investigator, Special Investigative Unit Coding-Miami Florida
Molina Healthcare —Saint Petersburg, FL
- $21.82 - $42.55 an hour
- Full-time
- Anatomy knowledge
- Clinic experience
- Research
- Health insurance
Field Investigator (FT & PT) – Orlando/Tampa, FL
Origin Investigations Inc —Tampa, FL
- $20 - $35 an hour
- Part-time
- Background check
- Military
- High school diploma or GED
Quick Apply
SIU Desk Investigator - Tampa
AssuranceAmerica —Tampa, FL
- Full-time
- Customer service
- Mid-level
- Office
Part Time SIU Investigator
The Robison Group —Tampa, FL
- $30 - $35 an hour
- Part-time
- Background check
- 5 years
- Computer literacy
Quick Apply
Citi Security and Investigative Services (CSIS) Senior Investigator- AVP
Citi —Tampa, FL
- $87,360 - $131,040 a year
- Weekends as needed
- Hybrid work
- Microsoft Outlook
- CPA
- 5 years
- Paid holidays
- Disability insurance
1d
FINTECH INVESTIGATOR - 41000172 1
The State of Florida —Tampa, FL
- $66,188.20 a year
- Extended hours
- Writing skills
- Master's degree
- Analysis skills
- Paid holidays
- Dental insurance
4d
Skip Trace Investigator
Provest LLC —Tampa, FL
- $20 an hour
- Extended hours
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Paid training
- On-the-job training
Experienced Background Investigator (Onsite)
CACI —Tampa, FL
- $26.07 an hour
- Part-time
- Writing skills
- English
- Research
- Health insurance
10d
Licensed Covert Surveillance Investigator - Part Time - Tampa, FL
Meridian Investigative Group, Inc —Tampa, FL
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills
Licensed Covert Surveillance Investigator - Full Time - Tampa, FL
Meridian Investigative Group, Inc —Tampa, FL
- $20 - $30 an hour
- Extended hours
- Microsoft Word
- Computer literacy
- Writing skills
1099 Surveillance Investigator
KeySource Investigations —Tampa, FL
- $40 - $50 an hour
- Part-time
- Bilingual
- Microsoft Word
- Background check
Quick Apply
1d
Affirmative Civil Enforcement (ACE) Investigator
Contact Government Services, LLC —Tampa, FL
- $51,435.30 - $66,131.10 a year
- Full-time
- Hybrid work
- Microsoft Access
- Microsoft Outlook
- Office
- Health insurance
- Dental insurance
Quick Apply
Clinical Research Coordinator I - Heme | Myeloid
Moffitt Cancer Center —Tampa, FL
- $26.32 - $40.14 an hour
- Full-time
- Hybrid work
- Psychology
- Business Administration
- Business
- Paid training
- Relocation assistance
Principal Investigator
Care Access —Brandon, FL
- $200,000 - $400,000 a year
- Part-time
- Medicine
- Pass drug screening
- Travel
- Health savings account
- Paid holidays
Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)
Ultimate Health Plans —Tampa, FL
- From $75,000 a year
- Full-time
- Anatomy knowledge
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
COMMISSION INVESTIGATOR (PART TIME) - 78003071
The State of Florida —Tampa, FL
- $22,077.36 a year
- Part-time
- Background check
- Computer literacy
- Writing skills
2d
CLINICAL RESEARCH COORDINATOR II
Moffitt Cancer Center —Tampa, FL
- $29.05 - $44.28 an hour
- Full-time
- Hybrid work
- Word processing
- Writing skills
- Mid-level
NTRO RESEARCH COORDINATOR II
Moffitt Cancer Center —Tampa, FL
- $22.74 - $34.68 an hour
- Full-time
- Hybrid work
- No experience needed
- Mid-level
- Master's degree
- Dental insurance
- Paid time off
MYEOMA & LYMPHOMA RESEARCH DATA COORDINATOR III
Moffitt Cancer Center —Tampa, FL
- $24.45 - $37.31 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Associate's degree
Senior Financial Investigator
Contact Government Services, LLC —Tampa, FL
- $74,156.16 - $107,114.45 a year
- Full-time
- Hybrid work
- Mid-level
- Driver's License
- Presentation skills
- Health insurance
- Dental insurance
Quick Apply

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field investigator jobs near tampa, fl

Investigator, Special Investigative Unit Coding-Miami Florida

Molina Healthcare -
Saint Petersburg, FL

Apply Now

Job Details

Full-time
$21.82 - $42.55 an hour

Benefits

Health insurance

Qualifications

Anatomy knowledge
Investigations regulatory compliance
Medicare
Managed care
Spreadsheets
Health insurance policy knowledge
Research
Regulatory legal research
Insurance regulation
Medicare regulations
Medical coding for surgical records
Insurance investigations
Medicaid regulations
Medicaid
Productivity software
Medical terminology
Excel data analysis

Full Job Description

JOB DESCRIPTION

Provides investigative support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA). Investigates and resolves instances of health care fraud and abuse investigations of medical providers using informational tips from member benefits and medical records following review of post-payment claims.

Essential Job Duties

Independently re-evaluates medical claims and associated records by applying knowledge of advanced coding, all relevant and applicable Federal and State regulatory requirements, and Molina policies.
Reviews post-pay claims against corresponding medical records to determine accuracy of claims payments.
Manages documents and prioritizes caseloads to ensure timely turnaround.
Ensures adherence to applicable state/federal/internal policies, Current Procedural Terminology (CPT) guidelines and provider contract requirements.
Devises clinical summary post-review.
Communicates and participates in meetings related to cases.
Completes medical review to facilitate referral to law enforcement or payment recovery.
Supports investigation work as necessary and required by the regulatory agency.

Job Requirements

At least 2 years CPT coding experience in a surgical, hospital and/or clinic setting, or equivalent combination of relevant education and experience.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or American Academy of Professional Coders (AAPC) certified
Critical-thinking, problem-solving and analytical skills.
Ability to prioritize and manage multiple tasks.
Ability to work in a team setting.
Strong verbal/written communication skills, and presentation skills.
Microsoft Office suite (including Excel), and applicable software program(s) proficiency.
In some states, 5 years of experience working in a fraud, waste and abuse (FWA)/special investigations unit (SIU)/fraud investigations role may be required (dependent on state/contractual requirements).
Knowledge of investigative and law enforcement procedures with emphasis on fraud investigations.
Knowledge of Managed Care and the Medicaid, Medicare, and Marketplace programs.
Understanding of claim billing codes, medical terminology, anatomy, and health care delivery systems.
Ability to research and interpret regulatory requirements.

Preferred Qualifications

Certified Professional Compliance Officer (CPCO).
Certified Fraud Examiner (CFE) and/or Accredited Health Care Fraud Investigator (AHFI).
Experience working in group health insurance, particularly within claims processing or operations.
Working knowledge of local, state and federal laws and regulations pertaining to health insurance, investigations and legal processes (commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.).
Experience with claims processing systems.
Ability to use Microsoft Excel/Access platforms working with large quantities of data.
Ability to answer questions, identify trends and patterns, and present findings.

#PJCorp

#LI-AC1

To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $21.82 - $42.55 / HOURLY

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

field investigator jobs in tampa, fl

Investigator, Special Investigative Unit Coding-Miami Florida

Field Investigator (FT & PT) – Orlando/Tampa, FL

SIU Desk Investigator - Tampa

Part Time SIU Investigator

Citi Security and Investigative Services (CSIS) Senior Investigator- AVP

FINTECH INVESTIGATOR - 41000172 1

Skip Trace Investigator

Experienced Background Investigator (Onsite)

Licensed Covert Surveillance Investigator - Part Time - Tampa, FL

Licensed Covert Surveillance Investigator - Full Time - Tampa, FL

1099 Surveillance Investigator

Affirmative Civil Enforcement (ACE) Investigator

Clinical Research Coordinator I - Heme | Myeloid

Principal Investigator

Special Investigation Unit (SIU) Lead/Investigator (Medicare Advantage Plan)

COMMISSION INVESTIGATOR (PART TIME) - 78003071

CLINICAL RESEARCH COORDINATOR II

NTRO RESEARCH COORDINATOR II

MYEOMA & LYMPHOMA RESEARCH DATA COORDINATOR III

Senior Financial Investigator

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