Program Integrity Investigative Coordinator I (Hybrid)

Program Integrity Investigative Coordinator I

The Program Integrity Investigative Coordinator I monitors and maintains all SIU fraud reporting mechanisms to ensure compliance with regulatory requirements. Essential functions include : accurately loading Fraud, Waste & Abuse referrals into the SIU Case Management System, analyzing FWA allegation facts, evaluating cases, interviewing claimants, reviewing claims, generating reports, conducting data analysis, maintaining anonymity and confidentiality, identifying billing errors, requesting medical records, assisting with oversight of Delegated Entities, preparing and documenting informational letters, supporting compliance and regulatory requirements, driving accuracy of database information, and upholding the provisions of the Corporate Compliance Plan.

Education and experience : High School Diploma or GED is required. An Associate's Degree in Health-Related Field, Law Enforcement, or Insurance is preferred. Minimum of three (3) years' experience in a health care related field or Customer Service is required. Health care experience preferred.

Competencies, knowledge, and skills : Intermediate computer skills, good communication skills, ability to work independently and within a team environment, high attention to detail, critical listening and thinking skills, proper grammar usage, time management skills, proper phone etiquette, customer service oriented, decision making / problem solving skills, and strong organization skills.

Licensure and Certification : None

Working Conditions : General office environment; may be required to sit or stand for extended periods of time.

Compensation Range : $40,400.00 - $64,700.00