CVS Health SIU Senior Investigator (Remote - Must be in Oklahoma) in Oklahoma City, Oklahoma
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
This position can be work from home in the State of Oklahoma. Must be willing to work CDT schedule. - Conducts more high level, complex investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and practices.- Conducts investigations of known or suspected acts ofhealthcare fraud and abuse.- Communicates with federal, state, and local lawenforcement agencies as appropriate in matterspertaining to the prosecution of specific healthcare fraudcases.- Investigates to prevent payment of fraudulent claimscommitted by insured's, providers, claimants, customermembers, etc.- Facilitates the recovery of company and customermoney lost as a result of fraud matters.- Provides input regarding controls for monitoring fraudrelated issues within the business units.- Delivers educational programs designed to promotedeterrence and detection of fraud and minimize losses tothe company- Maintains open communication with constituents withinand external to the company.- Uses available resources and technology in developingevidence, supporting allegations of fraud and abuse.- Researches and prepares cases for clinical and legalreview.- Documents all appropriate case activity in trackingsystem.- Makes referrals and deconflictions, both internal and external, in the required timeframe.- Cost effectively manages use of outside resources andvendors to perform activities necessary for investigations.- Exhibits behaviors outlined in Employee Competencies- Attending and presenting at state meetings.
Over 2 years in healthcare field working in fraud, waste and abuse investigations and audits.- Strong analytical and research skills.- Proficient in researching information and identifying information resources.- Strong verbal and written communication skills.- Strong customer service skills.- Ability to interact with different groups of people at different levels and provide assistance on a timely basis.- Proficiency in Word, Excel, MS Outlook products,- Database search tools, and use in the Intranet/Internet to research information.- Ability to utilize company systems to obtain relevant electronic documentation.- Ability to travel and participate in legal proceedings, arbitrations, depositions, etc.
Ability to travel up to 10%, based on business needs.
- Knowledge of Oklahoma Medicaid.- Credentials such as a certification from the Association ofCertified Fraud Examiners (CFE), an accreditation from the National Health Care Anti-Fraud Association (AHFI).- Billing and Coding certifications such as CPC (AAPC)and/or CCS (AHIMA)- Knowledge of Aetna's policies and procedures.
Education- Bachelor's degree and/or an Associate's degree or equivalent experience with two additional years working in health care fraud, waste, and abuse investigations and audits.
The typical pay range for this role is:
$43,700.00 - $90,000.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.