Provider Billing Investigator I

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Provider Billing Investigator I is 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 Investigator I compiles evidence and documents findings in investigative reports. Refers cases of fraud to law enforcement or state regulatory agencies. Additionally, Provider Billing Investigator I requires a bachelor's degree. Typically reports to a manager. The Provider Billing Investigator I work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Provider Billing Investigator I typically requires 0-2 years of related experience.