Director, Special Investigations Unit

Brigham and Women's Faulkner Hospital

Somerville, Massachusetts, United States
Base: $124,342.40 - $180,897.60/annual; bonus/equi...
Hybrid
Insurance audits and investigations
Medical billing and coding analysis
Fraud, waste, and abuse detection
The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance

Job Summary

  • The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance.
  • This role involves managing a team of clinical and non-clinical investigators, reviewing complex claims, and coordinating with law enforcement agencies on fraud matters.
  • Mass General Brigham offers competitive salaries, flexible work options, and comprehensive benefits including career growth opportunities within a supportive environment.

Matching Summary

The Director will lead the Special Investigations Unit to prevent, detect, and investigate healthcare fraud, waste, and abuse while ensuring regulatory compliance.

Salary

Base: $124,342.40 - $180,897.60/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package with flexible work options and career growth

Skills & Requirements

Must-have

  • Insurance audits and investigations
  • Medical billing and coding analysis
  • Fraud, waste, and abuse detection
  • Regulatory compliance monitoring
  • Team leadership and staff training

Nice-to-have

  • Strong analytical skills for audit results
  • Excellent communication for reporting findings
  • Project management for concurrent audits
  • Diversity, equity, and inclusion integration
  • Experience with state FWA regulatory meetings

Key Requirements

  • Bachelor's degree required; Master's preferred
  • Health care coding certification (CPS or CCS) required
  • Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) required
  • 5-7 years experience in insurance audits or investigations
  • 3-5 years experience in a management role
  • 6 years experience in health care payer or fraud control setting preferred

Work Rights

Not specified

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