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Sr Data & Coding Analyst
πŸ‘½ Really Something Else πŸ‘½

Brighthealthgroup is hiring a
Sr Data & Coding Analyst

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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


 

SCOPE OF ROLE

Under the direction of the SIU Manager, the Senior Analyst, Special Investigations Unit (SIU) will work to prevent, detect and investigate known or suspected acts of fraud. The Senior Analyst will be responsible for coordinating investigation activities, conducting comprehensive investigations of reported, alleged, or suspected fraud involving the full range of products at Bright Health, and contributing to the development and administration of Fraud, Waste, and Abuse (FWA) analytical tools.

ROLE RESPONSIBILITIES

The Senior Analyst, Special Investigations Unit job description is intended to point out major responsibilities within the role, but it is not limited to these items

  • Conducts advanced fraud, waste, and abuse coding audits in accordance with compliance and audit work-plan and prepares detailed audit reports for management, legal counsel, and other key stakeholders
  • Performs investigation of credible instances of suspected fraud, and coordinates communication with all parties involved
  • Performs data analysis to identify outliers and patterns that may lead to formal FWA investigations
  • Support the development of tools, templates, and strategies to proactively analyze data and identify potential FWA trends
  • Establish and maintain liaison with public officials, law enforcement and others to obtain assistance in conducting investigations
  • Fulfill response requests for Requests for Information (RFI) and other external requests from state and federal regulators, attorneys, and other entities as necessary

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

  • 3-5 years of experience preferred
  • Certified Professional Coder (CPC) or equivalent required
  • At least 2 years of experience performing SIU investigations at a healthcare company
  • Health insurance experience

PREFERRED COMPETENCIES

  • Bilingual Spanish and English speaking
  • Clinical training experience
  • Experience analyzing data and identifying patterns
  • Performed FWA-related audits at a health insurance company.
  • At least one of the following: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Anti-Money Laundering and Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar certification/credential.

WORK ENVIRONMENT

  • This job is a remote / flexible role and will not require in-office presence
 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
 
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
 
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
 
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
 
          

 
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 

 

How to Apply?
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