SIU Investigator

Hcfraudshield; Chesterfield (MO); Remote; USD 50,000 - 90,000; Full time

Job summary

Join a forward-thinking company as a SIU Investigator, where you'll play a crucial role in healthcare fraud prevention. This position involves analyzing medical records, ensuring compliance with coding standards, and collaborating with a dedicated team to uphold integrity in healthcare billing. The role offers a dynamic work environment with opportunities for professional growth and development. With a commitment to diversity and equal opportunity, the company values your unique contributions and offers a comprehensive benefits package, including medical, dental, and vision insurance, along with flexible work arrangements.

Benefits

Medical, Dental & Vision insurance

401(k) retirement savings with employer match

Vacation and sick paid time off

8 paid holidays

Paid maternity/paternity leave

Disability & Life insurance

Flexible Spending Account (FSA)

Employee Assistance Program (EAP)

Professional and career development initiatives

Qualifications

• Must have CPC certification or equivalent.
• Minimum one year of coding/billing experience required.

Responsibilities

• Analyze patient medical records for fraud investigations.
• Document findings and summarize in written reports.
• Maintain knowledge of coding guidelines and regulations.

Skills

Knowledge of medical terminology

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

Detail-oriented

Effective communication skills

Strong listening skills

Self-disciplined

Ability to meet performance goals

Strong computer skills

Education

Certified Professional Coder (CPC)

Minimum of one year coding/billing experience

Job description

SIU 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 Coder or Clinical Coder/Fraud Investigator to join our team.

Key Responsibilities

• Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts) including performing quality checks on work, assisting in research, and discussing 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 the amount and nature of billable services as needed.
• Determine appropriateness of billing and reimbursement as needed.
• Document findings for each claim line in a spreadsheet as needed.
• Summarize findings in a written report as needed.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed.
• Maintain 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.
• Understand and comply 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 and 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 or equivalent certification.
• 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.
• 8 paid 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.