Investigator, Special Investigation Unit

at  Providence Health Plan

REQUIRED QUALIFICATIONS FOR THIS POSITION INCLUDE:

• Bachelor’s Degree -OR- a combination of equivalent education and experience
• 5+ years coding experience at a healthcare provider, facility or health insurance company
• 2+ years fraud and abuse audit experience at a health plan, health insurance company, healthcare provider, facility or other relevant healthcare environment
• Project management experience, education program development experience and group presentation experience
• Experience in use of data mining software/tools

PREFERRED QUALIFICATIONS FOR THIS POSITION INCLUDE:

• Clinical background such as Registered Nurse (RN), Doctorate of Medicine (MD), or Doctor of Chiropractic (DC)
• Current certification as Certified Coding Professional (CPC)
• Current certification in health care fraud investigation, such as Accredited Healthcare Fraud Investigator (AHFI), Certification as an Internal Auditor (CIA), Healthcare Compliance certification (CHC), or equivalent
• Certification in Project Management or Agile (PMP, CSM, CSPO)
• Basic understanding of statistics and data analytics
• Basic understanding of analytics software (e.g.: SQL, Power BI, MS Access, Tableau, Alteryx) or a demonstrated interest in learning analytics software
• Advanced understanding of MS Excel and PowerPoint
• Professional communication skills, representing the SIU in verbal and written communications with executives, law enforcement, regulators, attorneys, physicians, members, etc.

• This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon

Providence Health Plan welcomes 100% remote work for applicants who reside in one of the following States:

• Washington
• Oregon
• California