Special Investigations Unit Investigator

This is a fully remote position, open to applicants in Oregon, +1 more state.

📋 Description

• Oversee fraud, waste, and abuse (FWA) responsibilities for CareOregon.

• Conduct investigations into fraud cases.

• Deliver regular reports regarding FWA activities.

• Design and implement a robust FWA program that complies with CMS standards.

• Execute routine FWA investigations, audits, and corrective measures.

• Compile reports detailing audit outcomes.

• Address both routine and ad hoc inquiries from external regulatory bodies.

• Generate regular and ad hoc reports for both internal and external leadership.

• Aid in the development and maintenance of a documentation system for FWA regulatory compliance.

• Evaluate and suggest revisions to policies and procedures.

• Participate in internal and external meetings focused on FWA and compliance.

• Support the delivery of effective FWA training and education for staff.

• Instruct providers on appropriate documentation and coding practices.

⛳️ Requirements

• At least 2 years of experience in FWA, compliance, and/or auditing within a highly regulated sector.

• Preference for experience with Oregon Medicaid or health plans.

• Certification as a CPC (Certified Professional Coder), RHIT (Registered Health Information Technician), or CFE (Certified Fraud Examiner).

• Familiarity with healthcare fraud, waste, and abuse issues.

• Knowledge of state and federal compliance and FWA regulations for Medicare and Medicaid.

• Proficiency in investigative methods, including interviews, data analysis, evidence collection, and case documentation.

• Strong skills in research, investigation, and problem-solving.

🏝️ Benefits

• Comprehensive medical, dental, vision, life, AD&D, and disability insurance.

• Health savings account.

• Flexible spending account(s).

• Lifestyle spending account.

• Employee assistance program.

• Wellness program.

• Discounts.

• A variety of supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.).

• A robust retirement plan with employer contributions.

• Paid time off (PTO) and Paid State Sick Time.

• Paid holidays, volunteer time, jury duty, bereavement leave, and more.