Remote SIU Investigator - Healthcare Fraud & Coding

Healthcare Fraud Shield; Chesterfield (MO); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote work eligible

401(k) retirement savings with company

Vacation and sick paid time off

7 paid holidays & 2 floating holidays

Job summary

Healthcare Fraud Shield is seeking an SIU Investigator to join our team at headquarters. You will collaborate with the SIU group to review clinical records, analyze CPT/ICD coding, and contribute to fraud investigations supporting client engagements.

The role requires CPC certification, coding experience, strong analytical and communication skills, and the ability to manage multiple investigations while upholding privacy standards. Remote work eligible.

Qualifications

• Certified Professional Coder (CPC) certification required
• Minimum of one year coding and/or billing experience required

Responsibilities

• Work with SIU Team to review and discuss coding determinations
• Analyze patient medical records for FWA investigations
• Compare claims information to determine billable services
• Determine appropriateness of billing and reimbursement
• Document findings in spreadsheets and reports
• Abstract CPT/HCPCS/Revenue Codes/DRG/ICD-9/ICD-10 from records
• Maintain knowledge of coding guidelines and regulations
• Perform data analysis and data mining of client data
• Conduct FWA investigations and provide SIU support
• Adhere to Privacy and Security standards and protect PHI

Skills

Medical terminology

CPT coding

HCPCS coding

DRG coding

ICD-10 coding

Detail oriented

Verbal & written communication

Active listening

Independent

Responsible

Self-disciplined

Performance & production goals

Computer skills

Privacy & security compliance

Education

CPC certification

1+ year coding/billing experience

Job description

Healthcare Fraud Shield is seeking an SIU Investigator to join our team at headquarters. You will collaborate with the SIU group to review clinical records, analyze CPT/ICD coding, and contribute to fraud investigations supporting client engagements.

The role requires CPC certification, coding experience, strong analytical and communication skills, and the ability to manage multiple investigations while upholding privacy standards. Remote work eligible.