Senior/Level Iii - Siu Investigator - Dental/Healthcare

Tooth Sleuth Wanted: Join Our Team as a Senior / Level III SIU Investigator in Oklahoma City, OK!

Location:

** Opportunity to work Fully Remote, based out of our Oklahoma City, OK office location. Residents of Oklahoma are highly preferred. We are unable to hire or allow employees to work outside of the United States.

The SIU Investigator is responsible for supporting the prevention, detection, investigation, reporting and, when appropriate, recovery of money related to health care fraud, waste, and abuse across the LIBERTY Dental Plan Enterprise. The position will collaborate with other internal departments, including Compliance, Corporate Legal Counsel, and Provider Relations, and coordinate with local/federal law enforcement units on joint investigations, to achieve and maintain appropriate anti-fraud oversight.

Job Summary Details

• Triage and manage caseloads including investigating allegations, complaints and issues pertaining to potential health care fraud by providers or members.

• Research allegations of fraud, waste, and abuse (FWA) to prevent, detect, and deter future FWA violations within all Plan Programs.

• Document investigations, including preliminary and final case reports, for both internal tracking and regulatory reporting.

• Develop summary reports that explain key findings in data evaluation.

• Thoroughly document all interactions and outcomes, in host system, for accurate tracking and analysis.

• Review data analytic outlier reports, working with internal departments to develop investigative leads in support of SIU initiatives to identify fraud, waste, and abuse.

• Analyze and proactively identify trends and aberrant activity to generate leads for fraud investigations and analyze claims data to detect fraudulent activity, recommending steps to mitigate recurrence.

• Efficiently navigate multiple systems to appropriately respond to inquiries and meet regulatory deadlines.

• Prepare cases for referral to law enforcement officials for prosecution and testify in criminal and civil matters as needed.

• Utilize FWA analytic systems and data mining techniques, statistical data analysis, and analytical software to identify potential overbilling in all Plan lines of business.

• Work with providers and LIBERTY staff to develop corrective action plans (CAPs) and monitor that the CAP corrects the FWA issue found.

• Attend seminars / webinars annually to stay current on fraud, waste, and abuse trends and issues.

• Support SIU Leadership, Compliance staff and legal counsel in all phases of investigation and litigation.

• Develop monitoring tools and benchmarks that allow the department to analyze results and evaluate effectiveness of SIU operations, results, and processes.

• Perform special assignments and other duties as assigned or as determined appropriate.

SIU Investigator III: Able to complete moderately complex to highly complex investigations, manage a high case load/number of investigations; Mentor and train Level I & II investigators; Demonstrate Advanced or certified dental coding knowledge;Minimum 7 to 10 years of investigative/dental audit experience. CPC/AAPC certification required, or equivalent investigative medical or dental audit experience in lieu of.

Education/Experience:

• 4 Year / Bachelors Degree in a related discipline or equivalent combination of education and experience.
• Demonstrate Advanced or certified dental coding knowledge.
• Minimum 7 to 10 years of investigative/dental audit experience.
• CPC/AAPC certification required, or equivalent investigative medical or dental audit experience in lieu of.

Specific Skills/Knowledge:

• Strong understanding of insurance reimbursement methodologies, including working knowledge of current dental claim coding requirements.

• Strong investigative skills with the ability to identify potential fraud, waste, or abuse.

• Ability to analyze and interpret information.

• Must have working knowledge of the managed health care business, including data analysis.

• Proficiency in Microsoft Office Applications, internet, and Social Media applications.

• Advanced skills in use of formulas and pivot tables to analyze, extract and compile clinical & financial data and reporting.

• Demonstrated ability to work independently, meet objectives and tight deadlines.

• Proven experience in managing multiple priorities and meeting deadlines/production goals.

• Strong organizational skills.

• Working knowledge of dental contracts, dental terminology, and dental treatment.

• Bilingual Spanish preferred.

Compensation:

In the spirit of pay transparency, we are excited to share the annual base salary for this position is $76,398 - $99,305, exclusive of fringe benefits or potential bonuses. If you are hired at LIBERTY, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and/or experience. In addition to those factors – we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth. We also offer a generous compensation and benefits package.

What LIBERTY Offers:

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their society. That’s why LIBERTY offers competitive and attractive benefit packages for their employees. We strive to care for employees in positive ways that promote wellness and productive employees.

LIBERTY Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. LIBERTY will leverage diverse perspectives in building high performance teams and organizational culture.

LIBERTY will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications:

LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.