Career Opportunities: Special Investigations Unit Investigator (24843) Requisition ID 24843 - Posted 02/20/2025 - Health Share of Oregon - Full Time - Permanent - Portland - Multi Location (18) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Special Investigations Unit Investigator Requisition # 24843 Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title Director of Compliance and Quality Oversight Department Health Share of Oregon Pay and Benefits Estimated hiring range $73,035 - $89,265 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a fully remote role, but you must reside in 1 of the listed 9 states (Must be able to work (9-3P.M. PST - Flexible if in Central Time). Job Summary This position is responsible for administering the fraud, waste, and abuse (FWA) duties for Health Share and its affiliated lines of business. Core work includes ensuring effective measures are in place and operating effectively to prevent, detect, and correct any instances of fraud, waste, and abuse. This includes performing fraud investigations and providing regular FWA reporting. Additionally, this position helps ensure that appropriate procedures are in place and followed consistently to safeguard its assets, verify the accuracy and reliability of data, and promote efficient and effective operations. Essential Responsibilities Assist in the development and operation of an effective FWA program in accordance with CMS requirements, OHA/OHP requirements, and the Federal Sentencing Guidelines with guidance from department leadership. Perform routine FWA investigations, audits, and corrective actions as assigned, including maintaining documents and providing routine updates; may assist senior investigator with more complex or advanced investigations. Prepare reports of audit findings; provide recommendations regarding improvements or corrective actions where a deficiency may exist. Prepare, proofread, and distribute correspondence, forms, and other information of a specialized and confidential nature. Respond to routine and ad hoc requests from external regulatory agencies as assigned, such as annual reviews, quarterly reports, and one-off requests. Prepare routine and ad hoc reports for internal and external leaders, committees, and governing body, including collecting, analyzing, and displaying data. Assist in developing and maintaining an organized, methodical documentation system for communicating, implementing, and administering new and existing FWA regulatory requirements. Review and recommend policy and procedure revisions that support the FWA/SIU program. Attend internal and external FWA and compliance-related meetings as assigned. Assist in providing effective FWA training and education to staff, both internal and external. Educate providers on appropriate documentation and coding. Participate in FWA program-related risk assessment and mitigation processes. Meet departmental metrics for key performance indicators. Organizational Responsibilities Perform work in alignment with the organization's mission, vision, and values. Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals. Strive to meet annual business goals in support the organization's strategic goals. Adhere to the organ