SIU Clinical Investigator

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.

• 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

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

Certified Professional Coder (CPC) required; minimum one year coding/billing experience; knowledge of medical terminology, CPT, HCPCS, ICD-10; strong computer skills; remote work with high-speed internet.

Key Responsibilities

• analyzing medical records
• coding claims
• conducting investigations

Job Details

• Category: Healthcare Services - Allied Health
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — United States
• Languages: English

Benefits

• 401k matching
• Generous paid time off
• Retirement plan
• Generous parental leave

About Healthcare Fraud Shield

A provider of AI-powered healthcare fraud, waste, and abuse detection solutions for healthcare payers. — Industry: Information Technology