Qualifications

• Bachelor's degree in business, finance, accounting, human resources, or related field required.
• Juris Doctor, Master of Science, or Master of Business Administration preferred.
• Experience performing investigations, particularly in a health care environment, highly preferred.
• Minimum of five years' experience in the health care industry.
• In-depth knowledge of regulatory requirements regarding health care compliance programs and Medicare billing rules highly preferred.
• Certified in Healthcare Compliance (CHC®) or other applicable professional certification required.
• Certified Fraud Examiner (CFE®) or Accredited Health Care Fraud Investigator (AHFI®) certifications a plus.

Responsibilities

• Coordinates investigative efforts with various Risk Management Units.
• Analyzes reports or investigation findings for patterns of misconduct or compliance weaknesses.
• Develops and oversees investigator training programs and materials.
• Provides instructor-led training on investigation processes.
• Ensures effective and consistent disciplinary measures in conjunction with HR and operational leaders.
• Performs hotline data analytics and creates reports based on hotline data.
• Chairs the Investigations Review Committee and contributes to the Compliance Newsletter.

Benefits

• Comprehensive benefits package including health insurance and retirement plans.
• Opportunities for ongoing professional development and training.
• Supportive work culture prioritizing integrity and compliance improvement initiatives.