Investigator, Coding Special Investigative Unit (Remote)

Siu Coding Investigator

The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.

Knowledge / Skills / Abilities :

• Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.
• Review of applicable policies, CPT guidelines, and provider contracts.
• Devise clinical summary post review.
• Communicate and participate in meetings related to cases.
• Critical thinking, problem solving and analytical skills.
• Ability to prioritize and manage multiple tasks.
• Proven ability to work in a team setting.
• Excellent oral and written communication skills and presentation skills.
• Medicare and Marketplace experience

Job Qualifications : Required Education :

Required Experience :

Required License, Certification, Association :

Preferred Education :

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Preferred License, Certification, Association :

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V. Pay Range : $24 - $51.06 / HOURLY