POSITION PURPOSE:
To develop, implement, and manage the day-to-day operations of the Company's Provider Audit and Special Investigations/Anti-Fraud programs. Achieve provider recoveries consistent with industry norms. Develop a broad presence in the Company and address questions concerning possible fraud and provider billing concerns.
MINIMUM POSITION REQUIREMENTS:
Required Experience:
*Five 5 years in health insurance, provider billing, health care fraud, or managed care
*Two 2 years supervisory or management
*Two 2 years provider billing or billing adjudication/auditing
Required Education:
*Bachelors degree in business, healthcare administration, nursing or similar area of study
Required Knowledge, Skills and Abilities KSAs :
Knowledge of:
*ICD-9, CPT, HCPCS and Medicare coding conventions and processes
Skills:
*Direct experience in provider billing or billing adjudication/auditing
*Interpersonal and written communication to interact with a wide variety of internal departments and external providers including physicians and facilities
*High degree of analytical ability and logical thought processing to identify and investigate problems, evaluate potential solutions, and present...

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