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Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/
Job Summary: The Special Investigations Unit is responsible for investigating and resolving high complexity healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. This position researches, gathers, and analyzes claims data, medical records, corporate policy, state/federal policy, and practice standards to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Responsible for conducting compliance audits, risk assessments, investigations, education relating to billing, coding, reimbursement, and documentations. This position is full-time.
Benefit Highlights:
About Universal Health Services:
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
QualificationsQualification and Requirements:
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS
and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.
If you would like to learn more about the opportunity, please contact Bridget Gomez at: bridget.gomez@uhsinc.com
Full Time
Hospital
$83k-98k (estimate)
05/08/2024
05/06/2025
uhsinc.com
SAN CARLOS, TX
>50,000
1979
DOUG MATNEY
$10B - $50B
Hospital
The following is the career advancement route for Clinical Investigator positions, which can be used as a reference in future career path planning. As a Clinical Investigator, it can be promoted into senior positions as an Appeal Resolution Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Clinical Investigator. You can explore the career advancement for a Clinical Investigator below and select your interested title to get hiring information.