Sr. SIU Investigator (Healthcare) - Community Health Choice - REMOTE OPTION
Harris Health System
Location: Houston, Texas
Type: Full Time
Internal Number: 159809
JOB SUMMARY: The Senior SIU Investigator performs reviews of claim lines flagged by Community's SIU and Community's SIU Contractor. The SIU Senior Investigator work assignments involving high level, moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. This position routinely handles cases that are sensitive, complex and/or high profile, involving multi-disciplinary provider groups, or cases involving multiple perpetrators or intricate healthcare fraud schemes. The Senior SIU Investigator cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of FWA matters.
REMOTE OPTION FOR TEXAS RESIDENTS ONLY
Education/Specialized Training/Licensure: Bachelor's degree required. Certification in Coding and Medical Billing, Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Investigator (CFE) certification required, or eligible to obtain within 1 year of employment.
Work Experience : Five (5) years fraud, waste, and abuse investigative experience in the healthcare industry and / or coding in the medical industry directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing.
Software Operated: Microsoft Office (Word, Excel, Outlook)
Other Requirements: - Experience training others within a SIU on FWA investigations processes preferred. - Solid Knowledge of Medicare, Medicaid and commercial investigations and coding practices.
1. Communication Skills: Above Average Verbal (Heavy Public Contact) Exceptional Verbal (e.g., Public Speaking) Writing /Composing: Correspondence / Reports
2. Other Skills: Medical Terminology, Research, MS Word, MS Excel
3. Advanced Education:
Advanced Training Specialty: Certification in Coding and Medical Billing, and Accredited Healthcare Fraud Investigator and/or Certified Fraud Investigator required.
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.