| Provider Billing Investigator III Job Description |
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| The following is a full job description for Provider Billing Investigator III. Here are the requirements and responsibilities for Provider Billing Investigator III along with statistics. If after reading this page you determine that Provider Billing Investigator III is not the position you are looking for, you may want to try one of these similar titles: Provider Billing Investigator I, Provider Billing Investigator II, Billing Analyst III, Billing Clerk III, Provider Billing Auditor, Provider Billing Investigation Manager, Provider Billing Senior Auditor, Billing Supervisor, Billing Manager |
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| Requirements and Responsibilities For Provider Billing Investigator III |
| 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 generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4-7 years of related experience. |
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| Also referred to as: Provider Billing & Fraud Investigator III |
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| Similar Jobs: Provider Billing Investigator I, Provider Billing Investigator II, Billing Analyst III, Billing Clerk III, Provider Billing Auditor, Provider Billing Investigation Manager, Provider Billing Senior Auditor, Billing Supervisor, Billing Manager |
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| Level of Education: Provider Billing Investigator III Salaries with No Diploma, Provider Billing Investigator III Salaries with a High School Diploma or Technical Certificate, Provider Billing Investigator III Salaries with an Associate's Degree, Provider Billing Investigator III Salaries with a Bachelor's Degree, Provider Billing Investigator III Salaries with a Master's Degree or MBA, Provider Billing Investigator III Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
