| Provider Billing Investigation Director Job Description |
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| The following is a full job description for Provider Billing Investigation Director. Here are the requirements and responsibilities for Provider Billing Investigation Director along with statistics. If after reading this page you determine that Provider Billing Investigation Director is not the position you are looking for, you may want to try one of these similar titles: Provider Billing Investigation Manager, Provider Billing Auditor, Provider Billing Investigator I, Provider Billing Investigator II, Provider Billing Investigator III, Billing Manager, Fraud Investigation Manager, Provider Billing Senior Auditor, Billing Supervisor |
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| Requirements and Responsibilities For 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. Compiles evidence and documents findings in investigative reports. Refers cases of fraud to law enforcement or state regulatory agencies. May take the lead on more complex investigations. Requires a bachelor's degree. Typically reports to senior management. 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. 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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| Also referred to as: Director of Fraud and Abuse Investigations, Director of Medical Fraud Prevention, Provider Billing & Fraud Investigation Director, Special Investigations Unit Director |
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| Similar Jobs: Provider Billing Investigation Manager, Provider Billing Auditor, Provider Billing Investigator I, Provider Billing Investigator II, Provider Billing Investigator III, Billing Manager, Fraud Investigation Manager, Provider Billing Senior Auditor, Billing Supervisor |
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| Level of Education: 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 |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
