Commonwealth Care Alliance
FWA Investigator Coder Sr. Associate (Remote)
PayCompetitive
LocationBoston/Massachusetts
Employment typeFull-Time
This job is now closed
Job Description
- Req#: 5001040645906
Employer Industry: Healthcare Compliance
Why consider this job opportunity:
- Competitive salary up to $80,000
- Opportunity for career advancement and growth within the organization
- Remote work flexibility
- Supportive and collaborative team environment
- Chance to make a positive impact on healthcare compliance and fraud prevention
What to Expect (Job Responsibilities):
- Conduct prospective and retrospective medical record reviews of claims
- Write detailed Memorandum of Findings for retrospective reviews
- Review internal and external referrals, claims, and medical records for compliance
- Document and track investigative activity in internal database
- Utilize data mining programs to analyze claims data for suspicious patterns
What is Required (Qualifications):
- Bachelor's Degree or equivalent experience
- CPC medical coding background
- Proficiency in Microsoft Office
- Experience and knowledge of CPT Coding
- Knowledge of federal and state laws related to fraud, waste, and abuse
How to Stand Out (Preferred Qualifications):
- Prior experience in health care compliance or related field
- Background in facility coding
#HealthcareCompliance #FraudPrevention #RemoteWork #CareerGrowth #CompetitiveSalary
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Based in Massachusetts, Commonwealth Care Alliance (CCA) is a not-for-profit, community-based healthcare organization dedicated to improving care for individuals who are dually eligible for MassHealth (Medicaid) and Medicare with complex medical, behavioral health and social needs, including persons with disabilities. CCA offers two health plans: Senior Care Options (HMO SNP), for individuals ages 65 and over who have Medicare and MassHealth Standard or only MassHealth Standard; and One Care, a Massachusetts demonstration program for dual eligible individuals ages 21 to 64. These comprehensive health plans provide all the services covered under Medicare and MassHealth, and other benefits as determined necessary by an inter-professional care team in conjunction with CCA’s preferred provider network. For four consecutive years, CCA’s One Care plan received a top consumer rating for quality and access in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) national survey of Medicare-Medicaid Plans (2016, 2017, 2018, and 2019), administered by the Centers for Medicare & Medicaid (CMS).