Remote SIU Clinical Investigator & CPC Coder

Hcfraudshield; United States; On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical and dental insurance

401(k) with employer match

Vacation and sick time off

7 paid holidays & 2 floating holidays

Remote work eligible

Job summary

Healthcare Fraud Shield is seeking an SIU Clinical Investigator to join our SIU team at headquarters. This full-time role involves clinical review, coding determinations, and fraud investigations within healthcare claims.

Ideal candidates hold CPC certification with at least one year of coding/billing experience and are detail-oriented, independent, and capable of clear written and verbal communication. Remote work eligibility is available.

Qualifications

• Must be CPC-certified with at least 1 year coding/billing experience.
• Experience with SIU investigations and clinical coding desirable.

Responsibilities

• Work with SIU Team to perform quality checks and discuss coding determinations.
• Analyze and interpret patient medical records for FWA investigations.
• Compare claims information to determine billable services and amounts.
• Determine appropriateness of billing and reimbursement.
• Document findings for each claim line in a spreadsheet.
• Summarize findings in written reports as needed.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from records.
• Maintain current knowledge of coding guidelines and regulations.
• Conduct data analysis of client data as needed.
• Perform various aspects of FWA investigations.
• Provide SIU support to clients as needed.
• Comply with Privacy and Security standards.

Skills

Medical terminology

CPT/HCPCS/DRG/ICD-10 coding

Specialty medical practices

Detail oriented

Verbal and written communication

Listening skills

Independent

Responsible

Self-disciplined

Performance goals

Computer skills

Confidential information handling

Education

CPC (AAPC) certification

Job description

Healthcare Fraud Shield is seeking an SIU Clinical Investigator to join our SIU team at headquarters. This full-time role involves clinical review, coding determinations, and fraud investigations within healthcare claims.

Ideal candidates hold CPC certification with at least one year of coding/billing experience and are detail-oriented, independent, and capable of clear written and verbal communication. Remote work eligibility is available.