| Provider Billing Investigation Manager Job Description |
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| The following is a full job description for Provider Billing Investigation Manager. Here are the requirements and responsibilities for Provider Billing Investigation Manager along with statistics. If after reading this page you determine that Provider Billing Investigation Manager is not the position you are looking for, you may want to try one of these similar titles: Provider Billing Investigation Director, Billing Manager, Fraud Investigation Manager, Provider Billing Auditor, Provider Billing Investigator I, Provider Billing Investigator III, Provider Billing Investigator II, Provider Billing Senior Auditor, Billing Supervisor |
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| Requirements and Responsibilities For Provider Billing Investigation Manager |
| Manages 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 a director. Manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. |
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| Also referred to as: Provider Billing & Fraud Investigation Manager |
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| Similar Jobs: Provider Billing Investigation Director, Billing Manager, Fraud Investigation Manager, Provider Billing Auditor, Provider Billing Investigator I, Provider Billing Investigator III, Provider Billing Investigator II, Provider Billing Senior Auditor, Billing Supervisor |
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| Level of Education: Provider Billing Investigation Manager Salaries with No Diploma, Provider Billing Investigation Manager Salaries with a High School Diploma or Technical Certificate, Provider Billing Investigation Manager Salaries with an Associate's Degree, Provider Billing Investigation Manager Salaries with a Bachelor's Degree, Provider Billing Investigation Manager Salaries with a Master's Degree or MBA, Provider Billing Investigation Manager Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
