Grants Pass, OR6 days ago
Work experience in investigations, with certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Professional Coder (CPC), Certification in Healthcare Compliance (CHC), or other fraud-related certifications, Knowledge of CPT Codes, ICD-10 Codes, Medicare Guidelines, OIG Work Plan priorities, Oregon Health Plan Contract Requirements, HIPAA, FWA and Compliance CFRs, Regulations and Statutes. The Compliance Specialist will cooperate and assist in submitting appropriate referrals and case documentation to enforcement agencies such as the Medicaid Fraud Unit (MFCU), Office of Program Integrity (OPI), Office of Inspector General (OIG), Department of Justice (DOJ), Centers for Medicaid and Medicare Services (CMS) and the Oregon Health Authority (OHA) for auditing, monitoring and oversight of external subcontractors (delegates).