Senior SIU Auditor: Healthcare Fraud & Coding Expert

Premera; Mountlake Terrace (WA); Ibrido; USD 70.000 - 118.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

401K match

Tuition assistance

On-site parking

Hybrid work

Descrizione del lavoro

Premera in Mountlake Terrace, WA, is seeking a Senior SIU Auditor to investigate healthcare fraud, waste, abuse, and coding irregularities across claims and reimbursement. This role requires advanced auditing expertise and strong judgment to lead proactive audit initiatives.

You will review CPT, HCPCS, ICD-10-CM coding, perform data analyses, prepare clear findings, and collaborate with internal and external partners.

Competenze

• Bachelor’s degree in a related field or equivalent education/experience.
• 5 years of healthcare coding, auditing, SIU, compliance investigation, claims analysis, appeals, provider dispute, or related experience.
• Active CPC and AHFI credentials.
• Additional certifications such as CPC-P, CPMA, CCS, CFE, or CHC preferred; Experience with SIU case management systems, SQL, Excel, and data analytics or audit tools.
• Advanced knowledge of coding methodologies, healthcare compliance requirements, and fraud, waste, and abuse indicators.
• Strong analytical, problem-solving, communication, and presentation skills.

Mansioni

• Audit and Coding Review of medical claims, provider billing, coding, and documentation; validate CPT/HCPCS/ICD-10-CM accuracy.
• Investigative Analysis and Fraud Prevention of billing trends; develop prevention strategies and remediation actions.
• Reporting, Compliance, and Case Documentation of audit findings and overpayments; maintain confidentiality and legal compliance.
• Legal Support, Collaboration, and Operational Execution; manage multiple audits, coordinate stakeholders, mentor juniors.

Conoscenze

Analytical skills

Communication skills

Presentation skills

Formazione

Bachelor's degree in a related field

Active CPC credential

AHFI credential

CPC-P CPMA CCS CFE CHC certifications

Strumenti

SQL

Excel

Descrizione del lavoro

Premera in Mountlake Terrace, WA, is seeking a Senior SIU Auditor to investigate healthcare fraud, waste, abuse, and coding irregularities across claims and reimbursement. This role requires advanced auditing expertise and strong judgment to lead proactive audit initiatives.

You will review CPT, HCPCS, ICD-10-CM coding, perform data analyses, prepare clear findings, and collaborate with internal and external partners.