Job Summary
The Special Investigation Unit (SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting, and when appropriate, recovery of money related to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU Investigator is responsible for reviewing and analyzing information to draw conclusions on allegations of FWA and/or may determine appropriateness of care. The SIU Investigator is also responsible for recognizing and adhering to national and local coding and billing guidelines in order to maintain coding accuracy and excellence. The position entails producing audit reports for internal and external review and may involve working with other internal departments, including Compliance, Corporate Legal Counsel, and Medical Officers to maintain appropriate anti-fraud oversight.
Job Duties
Job Qualifications
Compensation Information
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