Auditor/Investigator, Program Integrity Unit (PIU) Corporate Chicago, Illinois Evolent Health is looking for an Auditor/Investigator in our Program Integrity Unit, to be a key member of the Legal & Compliance Department. This individual will work as part of the Program Integrity Unit to assist in executing Evolent Healths mission by ensuring that Evolent maintains an effective compliance program which includes measures to prevent, detect and correct fraud, waste and abuse. Responsibilities: * Perform target claim audits (desk and on-site) as directed; distribute audit reports by the required due date. * Conduct investigations, including but not limited to, data analysis, record review, provider office inspections, and field observations. * Communicate audit findings internally to the Program Integrity Unit, as well as to DMS, OIG, OAG and other regulatory entities as needed. * Serve as an integral attendee and contributor at Program Integrity Unit meetings. * Gather and review data in response to inquiries sent to the Program Integrity Unit. * Handle Fraud/ Waste/ Abuse hotline calls and e-mails, respond to messages received and track receipt of calls/ e-mails. * Assist in development and implementation of Fraud/ Waste/ Abuse policies and procedures. * Maintain up-to-date notes, documentation on respective case load in the Investigation Database. * Assist in planning, development, and delivery of Fraud/ Waste/ Abuse related educational training for the company and providers. * Act as the Program Integrity Unit Liaison to assigned company departments to provide educational information and solicit feedback. * Work with subcontractor program integrity unit representatives during on-going investigations. * Maintain confidentiality of all sensitive investigative/audit information. * Perform other duties and projects as assigned. The Experience Youll Need (Required): * 3-5 years of experience in the managed care industry. * 1-2 years of experience in fraud, waste and abuse investigating in a healthcare operation. * Certified Coder with either CPC, CCS or CMPA (*Certified Professional Coder, Certified Coding Specialist, Certified Professional Medical Auditor) * Knowledge of corporate investigative practices. * Proficient understanding of medical terminology, human anatomy, medical tests and procedures, and health conditions. * Leadership skills to effectively communicate with staff and regulatory representatives. * Investigative, decision-making, problem solving, interpersonal and organizational skills. * Consistent demonstration of accuracy, thoroughness and timeliness in completing work assignments; detail-oriented. * Excellent ability to plan, organize and maintain multiple projects and files. * Excellent verbal and written communication skills and interpersonal skills. * Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system. * Ability to adapt to fluctuating situations. Finishing Touches (Preferred): * Bachelors degree. * Knowledge of healthcare services coding and claims billing. * Knowledge of Health Insurance, Managed Care, Benefit Design, Illinois Revised Statutes, Illinois Administrative Code and Federal Regulations. Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.