Coder-Healthcare Fraud Investigator

Presbyterian Healthcare Services(1 month ago)

RemoteFull TimeSenior$51,209.6 - $78,166.4Special Investigations Unit (Program Integrity)

About this role

The Investigator III at Presbyterian Health Plan works within the Special Investigations Unit (SIU) to support Program Integrity by identifying and addressing suspected healthcare fraud, waste, and abuse. The role focuses on preserving plan integrity across providers, pharmacies, members, and brokers while coordinating with government agencies and internal teams. This is a full-time remote position for workers based in New Mexico.

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Required Skills

Fraud Investigation
Medical Coding
Claims Analysis
Case Documentation
Provider Auditing
Overpayment Recovery
Legal Reporting
Interviewing
Regulatory Research
Systems Analysis

Qualifications

Bachelors Degree
Certified Professional Coder (CPC)
Certified Professional Medical Auditor (CPMA)
Certified Fraud Examiner (CFE)
Accredited Health Care Fraud Investigator (AHFI)

About Presbyterian Healthcare Services

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Find the medical care and health plan you and your family need at Presbyterian Healthcare Services, an integrated system of hospitals, healthcare providers and insurance plans serving patients and members in New Mexico.

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