Investigator External Audit Special Investigations Unit *Remote*

Investigator External Audit Special Investigations Unit *Remote*

The SIU Audit Investigator supports the compliance related activities of the Special Investigations Unit (SIU) at the Health Plan. This role assists the External Audit Senior Manager with developing, implementing and performing compliance related auditing and monitoring activities at the Health Plan. This includes the identification, investigation and correction of fraudulent and/or abusive billing and coding practices; coordination of recovery of overpayments related to fraudulent and/or abusive billing and coding practices; and providing education related to coding, medical record documentation requirements, healthcare compliance and fraud, waste and abuse to Health Plan staff, vendors and contracted providers/facilities.

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

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

• Washington
• Oregon
• California

Required Qualifications:

• Bachelor's Degree Or equivalent combination of education and experience.
• 5 years Coding experience with a healthcare provider, facility or health insurance company.
• 2 years Fraud and Abuse audit experience in a 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:

• Current certification as an Accredited Healthcare Fraud Investigator (AHFI) upon hire.
• Certification as an Internal Auditor or Healthcare Compliance certification upon hire.
• Clinical background.

Salary Range By Location:

• California: Humboldt: Min: $29.62, Max: $45.31
• California: All Northern California - Except Humboldt: Min: $33.23, Max: $50.84
• California: All Southern California - Except Bakersfield: Min: $29.62, Max: $45.31
• California: Bakersfield: Min: $28.41 Max: $43.47
• Oregon: Non-Portland Service Area: Min: $26.49, Max: $40.52
• Oregon: Portland Service Area: Min: $28.41 Max: $43.47
• Washington: Western - Except Tukwila: Min: $29.62, Max: $45.31
• Washington: Southwest - Olympia, Centralia & Below: Min: $28.41 Max: $43.47
• Washington: Tukwila: Min: $29.62, Max: $45.31
• Washington: Eastern: Min: $25.28, Max: $38.68
• Washington: South Eastern: Min: $26.49, Max: $40.52

Why Join Providence Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.  We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.  
 

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.