SIU Investigator

Healthcare Fraud Shield; Chesterfield (MO); Remote; USD 50,000 - 70,000; Full time

Benefits offered by this job

401(k) retirement savings with employer match

Paid time off (vacation and sick)

Paid holidays & floating holidays

Paid maternity/paternity leave

Disability & Life insurance

Flexible Spending Account (FSA)

Employee Assistance Program (EAP)

Professional and career development initiatives

Job summary

A leading company in healthcare fraud prevention is seeking a talented Coder or Clinical Coder/Fraud Investigator. This full-time role involves analyzing patient medical records, documenting findings, and ensuring compliance with coding guidelines. The position is remote work eligible, requiring a CPC certification and a minimum of one year of coding experience. Join a dedicated team committed to preventing healthcare fraud and ensuring payment integrity.

Qualifications

• Must have knowledge of medical coding guidelines.
• Requires access to confidential and sensitive information.
• Experience in healthcare fraud investigations is a plus.

Responsibilities

• Analyze and interpret patient medical records for fraud investigations.
• Document findings in spreadsheets and reports.
• Perform data analysis related to healthcare fraud.

Skills

Knowledge of medical terminology

Knowledge of coding (CPT, HCPCS, Revenue Codes, DRG Codes, ICD-10)

Detail oriented

Effective verbal and written communication

Ability to meet performance goals

Education

Certified Professional Coder - (CPC) through governing body AAPC or equivalent certification

Minimum of one year coding and/or billing experience

Job description

Beware of hiring scams where fraudulent actors impersonating our company and employees contact you directly to solicit your job application. Healthcare Fraud Shield will not contact you prior to having received your application.

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

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 (behavioral related and other specialties) pertaining to FWA investigations as needed
• Compare to information submitted on the claims in order to determine 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 and lead generation/data mining 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

KNOWLEDGE, SKILLS, & ABILITIES

• 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
• Responsible
• Ability to meet defined performance and production goals
• 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 or equivalent certification
• Minimum of one year of coding and/or billing experience is required.

BENEFITS

• 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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care, Software Development, and Technology, Information and Media

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