Senior Recovery Resolution Analyst job at reputed company in US National

Title: SIU Senior Recovery Resolution Analyst Location: United States Remote Requisition number: 2370585 Job category: Medical & Clinical Operations Overtime status: Non-exempt Travel: No Job Description: reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Employees are responsible for triaging, investigating, and resolving potential instances of healthcare fraud and/or abusive conduct by medical professionals or providers. Using information from tips, complaints, external intelligence or behavior data, the medical community and law enforcement, employees conduct confidential investigations and document relevant findings and report any illegal activities in accordance with reputed company laws and regulations. Identify, communicate, and recover losses as deemed appropriate. These investigations may include participation in telephone calls or meetings with providers, members, clients, legal compliance, and other investigative areas and requires adherence to state and federal compliance policies, reimbursement policies, and contract compliance. You will enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities: Gather and analyze data and information gathered to determine behavior and understand provider/scheme at issue Utilize appropriate documentation and tracking controls in the case tracking system to ensure compliance and auditability requirements are met Collaborate with SIU reputed company Investigator to apply knowledge of coding guidelines to determine validity of aberrances. Collaborate with a variety of external sources to identify reputed company and emerging patterns and schemes reputed company to FWA reputed company member and provider interviews, and review medical documentation as needed Communicate with legal, Law Enforcement, clients and business partners as needed reputed company reputed company other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: High School Diploma/GED 5+ years of experience working in a FWA / SIU or Fraud investigations role Certified Professional reputed company (CPC, reputed company, CPMA) or RHIT 2+ years of experience reputed company the health insurance claims industry 1+ years of knowledge and/or experience with medical/behavioral health codes and service delivery Intermediate level of proficiency in reputed company reputed company (pivot tables and macros) and Word (creating, editing, and saving documents) Preferred Qualifications: Associate's degree in Criminal Justice or experience in a reputed company field 2+ years of experience working with law enforcement or legal entities or 3+ years of investigative experience with fraud investigations Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar Familiar with CPT code terminology Experience with computer research Experience with regulatory compliance Experience with data analysis as it relates to financial recovery/settlements reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $24 to $43 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply To This Job