Medicaid Fraud Inspector Jobs (NOW HIRING)

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
Patient Revenue Management Organization
Pursue your passion for caring with the Patient Revenue Management Organization, which is the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
This position is 100% remote. All Duke University remote workers must reside in one of the following states:
North Carolina, Alabama, Arizona, Connecticut, District of Columbia, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Maine, Michigan, Missouri, Montana, New Hampshire, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington.
*Now offering a $10,000 sign-on bonus that will pay out in 4 equal installments over 24 months - 6-month increments.
Occ Summary
Implement and maintain compliance programs in accordance with the Office of Inspector General's work plan to reduce institutional and individual provider legal and financial risk through education and internal audits.
Work Performed
Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing an analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed. Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns; implementingcorrective actions as appropriate. Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures. Promote compliance initiatives with clinical faculty and administration. Perform other related duties incidental to the work described herein.
Knowledge, Skills and Abilities
Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing an analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focused reviews, and implement corrective action as needed. Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns, implementing corrective actions as appropriate. Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures. Promote compliance initiatives with clinical faculty and administration. Perform otherrelated duties incidental to the work described herein.
Level Characteristics
Educate providers regarding compliance with government regulations with special attention to Center for Medicare and Medicaid guidelines as they pertain to academic medical centers, HIPAA, and fraud and abuse with periodic updates. Assist in performing analysis of current situations and recommend priorities and goals for future clinic needs. Identify coding and billing risk areas, conduct focusedreviews, and implement corrective action as needed. Conduct routine internal audits of provider documentation on a timely basis. Collaborate with physicians and internal staff in the development of improved capabilities in the areas of documentation, coding, and compliance. Review internal controls, policies, and procedures to ensure compliance with appropriate university, state, and federal guidelines and policies, sound business and finance practices, and overall clinical goals and objectives. Respond promptly to external and internal concerns, implementing corrective actions as appropriate. Communicate with Medicare/Medicaid carriers and third-party payers regarding policies and procedures. Promote compliance initiatives with clinical faculty and administration. Perform other related duties incidental to the work described herein.
Minimum Qualifications
Education
Work requires organization, analytical and communication skills generally acquired through the completion of a Bachelor's degree program.
Experience
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions. For technical coding, two of the four years of experience with DRGs and APR-DRGs are required. Experience in formal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.
Degrees, Licensures, Certifications
Four years of administrative experience to acquire competence in applying compliance, coding and auditing principles as they relate to insurance billing, collections, consulting, and other revenue cycle-related functions. For technical coding, two of the four years of experience with DRGs and APR-DRGs are required. Experience informal teaching of coding is preferred. RHIA or RHIT or CCS required. For professional coding, specialty coding experience in surgical or E/M coding is preferred. CPC or CCS or RHIT or RHIA or CPMA is required.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.