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IEHP · 17 hours ago

Special Investigations (Healthcare) Investigator II

Rancho Cucamonga, CA

Full-time

Hybrid

Mid Level

$80K/yr - $106K/yr

4+ years exp

IEHP is a healthcare organization, and they are seeking a Special Investigations Unit Investigator II to investigate and analyze suspected cases of fraud, waste, and abuse within the healthcare environment. The role involves conducting investigations, ensuring compliance with regulations, and supporting the organization's Fraud, Waste, and Abuse Program.

Health CareHealth DiagnosticsHospital

Comp. & Benefits

Hiring Manager

Gaby Juarez, MA., BA., ACIR

Responsibilities

Investigating and analyzing suspected cases of fraud, waste, and abuse within the healthcare environment

Conducting comprehensive investigations, leveraging data analytics and other sources to identify unusual billing patterns and potential violations

Ensuring compliance with state and federal regulations, including CMS, HHS-OIG, DMHC, and DHCS requirements

Supporting the organization's Fraud, Waste, and Abuse (FWA) Program

Reporting findings to regulatory agencies

Implementing measures to prevent, detect, and correct fraudulent activities

Qualification

Healthcare fraud investigationData analyticsFederalState reportingAccredited Healthcare Fraud InvestigatorCertified Fraud ExaminerCertified Professional CoderCommunication skills

Required

Four (4) years or more of relevant professional experience in health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting

Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, Claims

Bachelor's degree from an accredited institution, in lieu of the required degree, a minimum of four years of additional relevant work experience is required for the position

Preferred

Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification

Benefits

Medical Insurance with Dental and Vision

Career and professional development

CalPERS retirement, 457(b) option with a contribution match

Company

IEHP

Glassdoor3.8

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans, the largest not-for-profit Medicare-Medicaid public health plan in the country, and for the fourth year in a row, certified as A Great Place To Work®.

Founded in 1995

Rancho Cucamonga, California, USA

1001-5000 employees