Hybrid SIU ICD10 Coder for Fraud, Waste & Abuse Audits

Fallon Health; Massachusetts; Hybrid; USD 79,000 - 96,000; Full time

Job summary

Fallon Health seeks an SIU ICD10 Professional Coder to join the Healthcare Fraud, Waste and Abuse team in Worcester, MA. The role is hybrid with 2 days in office, focusing on auditing medical records for E&M, DME and other services to identify potential over-payments and fraud indicators.

Responsibilities include coding audits, investigative support, pattern identification and collaboration with providers and clinical teams to ensure compliant billing.

Qualifications

• Bachelor's degree preferred or equivalent experience and prior experience in healthcare.
• Certified CPC and/or CCS is required; clinical experience preferred.
• CEMC or CPMA is a plus.
• 3-4 years of relevant experience.
• Knowledge of ICD-10CM/CPT, HCPCS and CMS rules.

Responsibilities

• Perform coding audits of medical records to verify ICD-10, CPT, HCPCS coding accuracy.
• Support investigations and communicate findings to stakeholders.
• Identify aberrant billing patterns and advise on improvements.
• Collaborate with providers, clinical teams, and external partners to ensure accurate billing.
• Maintain case documentation and department reports.

Skills

Analytical skills

Interpersonal skills

Written communication

Communication skills

Education

Bachelor's degree preferred or equivalent experience

CPC certification

CCS certification

CEMC certification

CPMA certification

Tools

ICD-10CM/CPT coding

HCPCS coding

CMS guidelines knowledge

Job description

Fallon Health seeks an SIU ICD10 Professional Coder to join the Healthcare Fraud, Waste and Abuse team in Worcester, MA. The role is hybrid with 2 days in office, focusing on auditing medical records for E&M, DME and other services to identify potential over-payments and fraud indicators.

Responsibilities include coding audits, investigative support, pattern identification and collaboration with providers and clinical teams to ensure compliant billing.