Provider Billing Investigation Director
Provider Billing Investigation Director directs and oversees the team 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. Being a Provider Billing Investigation Director compiles evidence and documents findings in investigative reports. Refers cases of fraud to law enforcement or state regulatory agencies. Additionally, Provider Billing Investigation Director may take the lead on more complex investigations. Requires a bachelor's degree. Typically reports to senior management. The Provider Billing Investigation Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Provider Billing Investigation Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function.
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- Provider Billing Investigation Director Salaries with No Diploma
- Provider Billing Investigation Director Salaries with a High School Diploma or Technical Certificate
- Provider Billing Investigation Director Salaries with an Associate's Degree
- Provider Billing Investigation Director Salaries with a Bachelor's Degree
- Provider Billing Investigation Director Salaries with a Master's Degree or MBA
- Provider Billing Investigation Director Salaries with a JD, MD, PhD or Equivalent