SIU Clinical Investigator

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

Benefits offered by this job

Medical, Dental & Vision insurance

401(k) retirement savings withEmployer

Vacation and sick paid time off

7 paid holidays & 2 floating holidays

Remote work eligible

Job summary

Healthcare Fraud Shield is seeking a qualified SIU Clinical Investigator to join our team at Headquarters. You will analyze medical records, code using CPT/HCPCS/DRG/ICD-10, and support FWA investigations with detailed reports.

In this full-time role, you will collaborate with the SIU team, ensure privacy and security compliance, and maintain current coding knowledge. Remote work is permitted where applicable.

Qualifications

• A CPC certification is required or equivalent.
• Minimum of one year of coding and/or billing experience.
• Strong knowledge of CPT, HCPCS, DRG, ICD-10 coding.

Responsibilities

• Collaborate with the SIU team to review cases and determine coding outcomes.
• Analyze patient records for FWA investigations and CPT/ICD-10 coding.
• Abstract codes and document findings in project spreadsheets.
• Prepare written findings reports for each claim.
• Maintain up-to-date knowledge of coding guidelines and regulations.
• Ensure privacy and security compliance in all activities.

Skills

CPT/HCPCS/DRG/ICD-10 coding

Medical terminology

Attention to detail

Verbal and written communication

Independent

Privacy and security awareness

Data analysis

Education

Certified Professional Coder (CPC) – AAPC

Job description

SIU Clinical Investigator

Department: SIU

Employment Type: Full Time

Location: Headquarters

Description

Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Clinical Coder/Fraud Investigator to join our team.

Key Responsibilities

• Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed).
• Analyze and interpret patient medical records pertaining to FWA investigations as needed.
• Compare information submitted on the claims to determine the amount and nature of billable services as needed.
• Determines appropriateness of billing and reimbursement as needed.
• Documents findings for each claim line in a spreadsheet as needed.
• Summarize findings in a written report as needed.
• Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
• Perform data analysis of client data as needed.
• Conduct various aspects of FWA investigations as needed.
• Provide Subject Matter Expertise and SIU support to clients as needed.
• Comply with Privacy and Security standards.
• Understands and complies with all company Privacy and Security standards.
• Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
• Other duties as needed.

Skills, Knowledge and Expertise

• Knowledge of medical terminology.
• Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
• Knowledge of specialty medical practices.
• Must be detail-oriented.
• Ability to communicate effectively both verbally and in writing.
• Strong listening skills.
• Independent.
• Responsible.
• Self-disciplined.
• Ability to meet defined performance and production goals.
• Strong computer skills.
• This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Certificate/License:

• Certified Professional Coder - (CPC®) through governing body AAPC.
• Minimum of one year of coding and/or billing experience is required.

Benefits

• Medical, Dental & Vision insurance
• 401(k) retirement savings with employer match
• Vacation and sick paid time off
• 7 paid holidays & 2 floating holidays
• Paid maternity/paternity leave
• Disability & Life insurance
• Flexible Spending Account (FSA)
• Employee Assistance Program (EAP)
• Professional and career development initiatives
• Remote work eligible

REMOTE WORK REQUIREMENTS:

• Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.

Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.