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PA Licensed RN Fraud Investigator
A company is looking for a RN Fraud Investigator. Key Responsibilities Identify discrepancies in paid claims and analyze patterns for potential fraud Review and evaluate cases for compliance with regulations and medical necessity Prepare case findings and coordinate with legal counsel for hearings and sanctions Required Qualifications RN License in Pennsylvania Experience in claims analysis and fraud detection Knowledge of State and Federal healthcare regulations Proficiency in using Word and Excel for report preparation Ability to participate in teleconferences and meetings as needed
A company is looking for a RN Fraud Investigator.
Key Responsibilities
Identify discrepancies in paid claims and analyze patterns for potential fraud
Review and evaluate cases for compliance with regulations and medical necessity
Prepare case findings and coordinate with legal counsel for hearings and sanctions
Required Qualifications
RN License in Pennsylvania
Experience in claims analysis and fraud detection
Knowledge of State and Federal healthcare regulations
Proficiency in using Word and Excel for report preparation
Ability to participate in teleconferences and meetings as needed
