| Provider Billing Investigator I Job Description |
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| The following is a full job description for Provider Billing Investigator I. Here are the requirements and responsibilities for Provider Billing Investigator I along with statistics. If after reading this page you determine that Provider Billing Investigator I is not the position you are looking for, you may want to try one of these similar titles: Provider Billing Investigator III, Provider Billing Investigator II, Billing Analyst I, Billing Clerk I, Provider Billing Auditor, Provider Billing Investigation Manager, Billing Manager, Provider Billing Senior Auditor, Billing Supervisor |
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| Requirements and Responsibilities For Provider Billing Investigator I |
| Responsible for investigating and auditing healthcare providers to detect and prevent medical billing fraud, waste, and abuse. Reviews medical billing and insurance claims to identify billing anomalies, outliers, and patterns of upcoding, phantom billing, or duplicate charges. Compiles evidence and documents findings in investigative reports. Refers cases of fraud to law enforcement or state regulatory agencies. Requires a bachelor's degree. Typically reports to a manager. Work is closely managed. Works on projects/matters of limited complexity in a support role. Typically requires 0-2 years of related experience. |
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| Also referred to as: Provider Billing & Fraud Investigator I |
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| Similar Jobs: Provider Billing Investigator III, Provider Billing Investigator II, Billing Analyst I, Billing Clerk I, Provider Billing Auditor, Provider Billing Investigation Manager, Billing Manager, Provider Billing Senior Auditor, Billing Supervisor |
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| Level of Education: Provider Billing Investigator I Salaries with No Diploma, Provider Billing Investigator I Salaries with a High School Diploma or Technical Certificate, Provider Billing Investigator I Salaries with an Associate's Degree, Provider Billing Investigator I Salaries with a Bachelor's Degree, Provider Billing Investigator I Salaries with a Master's Degree or MBA, Provider Billing Investigator I Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
