Investigator III-ABQ
Presbyterian Healthcare Services(1 month ago)
About this role
An Investigator III at Presbyterian Health Plan operates within the Program Integrity / Special Investigations Unit focused on detecting and preventing healthcare fraud, waste, and abuse across the health plan. This is a full-time, remote position based in New Mexico that supports Medicaid, Medicare, Marketplace, and commercial lines of business. The role requires relevant healthcare experience and industry certifications in coding or fraud investigation.
Required Skills
- Fraud Investigation
- Medical Coding
- Claims Analysis
- Case Documentation
- Interviewing
- Overpayment Recovery
- Regulatory Research
- Provider Education
- Data Analysis
- Report Preparation
Qualifications
- Bachelors Degree
- Certified Professional Coder (CPC)
- Certified Professional Medical Auditor (CPMA) - Preferred
- Certified Fraud Examiner (CFE) - Preferred
- Accredited Health Care Fraud Investigator (AHFI) - Preferred
About Presbyterian Healthcare Services
phs.orgFind 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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