Senior Clinical Investigator Consultant

A company is looking for a Senior Clinical Investigative Consultant Meritain (TPA)-Remote. Key Responsibilities Review provider medical records for clinical appropriateness and prepare summaries of findings Conduct complex investigations into suspected fraud, waste, and abuse, and document case activities Mentor teammates and collaborate with various stakeholders on special investigations Required Qualifications, Training, and Education Experience in medical record audits and coding reviews Knowledge of state and federal guidelines related to healthcare audits Ability to articulate findings to investigators and legal counsel Experience in conducting investigations of healthcare fraud, waste, and abuse Ability to maintain accurate records and documentation

Apr 11, 2025 - 08:56

A company is looking for a Senior Clinical Investigative Consultant Meritain (TPA)-Remote. Key Responsibilities Review provider medical records for clinical appropriateness and prepare summaries of findings Conduct complex investigations into suspected fraud, waste, and abuse, and document case activities Mentor teammates and collaborate with various stakeholders on special investigations Required Qualifications, Training, and Education Experience in medical record audits and coding reviews Knowledge of state and federal guidelines related to healthcare audits Ability to articulate findings to investigators and legal counsel Experience in conducting investigations of healthcare fraud, waste, and abuse Ability to maintain accurate records and documentation