Job Description

Siu Investigator

Come Find Your Spark at Quartz! We are seeking a self-motivated, detail-oriented professional to join our Compliance Team as a SIU Investigator. The SIU Investigator will conduct both routine and complex healthcare fraud, waste, abuse, and error investigations in an independent manner. This position will identify, investigate, and prevent healthcare fraud, waste, abuse, and error. This role will also utilize claims data, billing & coding guidelines, and other sources of information to identify abnormal billing practices and patterns. The SIU Investigator will be responsible for conducting investigations and documents all findings in clear, concise, and timely reports.

Benefits:

• Quartz supports a healthy work-life balance, including opportunities for professional growth and development.
• This position provides the options to work in-person, hybrid, or remotely from home.
• Starting annual salary is based upon skills and experience: $60,100 - $75,200 plus robust benefits package

Responsibilities

• Analyzes billing and coding patterns and identifies abnormal patterns and high-risk practices.
• Conducts data mining activities using available tools (analytical software, reports, and internal databases).
• Integrates artificial intelligence (AI) tools into traditional investigative methods while maintaining compliance with agency PHI safeguards and HIPPA requirements.
• Prepares and submits complete, accurate, informative, and concise investigative reports.
• Thoroughly records ongoing investigations and investigative activities within case management software.
• Calculates and reports case savings, recoveries, and prevented losses for both internal tracking and regulatory reporting.
• Researches and responds to coding questions from internal and external clients.
• Reports suspected fraud, waste, and abuse to appropriate federal or state government regulators.
• Attends and participates in bi-monthly SIU Oversight Committee Meetings to discuss SIU activities and specific case details.
• Participates in regional and national workgroups and/or regulatory meetings for case-sharing, networking, and training as directed by leadership.

Qualifications

• Bachelor's degree with 2+ years of health care fraud investigations experience
• OR Associate degree with 5+ years of health care fraud investigations experience
• OR High school equivalency with 8+ years of health care fraud investigation experience
• Strong knowledge of health insurance, managed care, benefit design, billing/coding terminology including strong understanding of governmental medical payment policies/regulations
• Strong understanding of laws, regulations, and practices regarding fraud, waste, and abuse
• Analytical and problem-solving skills
• Experience working with health care providers
• Advanced level of proficiency with Microsoft Office (Word, Excel, PowerPoint, and Outlook)
• Ability to manage analyze large volumes of data from various internal and external sources and develop recommendations
• Goal oriented with the ability to work independently to successfully investigate complex issues
• Excellent written and oral communication skills with ability to build relationships with internal customers.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified person with disability.

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