[Hiring] SIU Investigator @Hcfraudshield - ID-5348

Role Description

Healthcare Fraud Shield is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team.

• 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 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

Other Jobs You May Be Interested In

• 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

Qualifications

• 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

Requirements

• 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