SIU Investigator
Healthcare Fraud Shield · United States · posted today ago
Listing supplied by Himalayas. 101 Careers did not originate this post and applications are handled by the employer.
About this role
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 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
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
- 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
- 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
- Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
Originally posted on Himalayas