Senior Fraud Investigator-NYC (Hybrid)
1199SEIU Funds
- Seniority
- Senior
About the role
Responsibilities • Conducts investigations into allegations of fraud, waste, or abuse, including preliminary assessments and full end-to-end case work. • Reviews and analyzes medical records, claims data, enrollment data, and other documentation to evaluate potential FWA. • Performs coding, billing, reimbursement, and medical necessity assessments based on CPT, HCPCS, ICD-9/10, DRG, and related coding guidelines. • Uses advanced data mining techniques to identify aberrant billing patterns, outli…
Read the full description on the original posting.
Perks & benefits
- Medical Insurance
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