Arizona Licensed Coding Investigator

A company is looking for an Investigator, Coding Special Investigative Unit (Remote).

Key Responsibilities

Investigate and resolve healthcare fraud and abuse by reviewing post pay claims and medical records

Document findings and manage case load to ensure timely resolution in compliance with policies and guidelines

Facilitate referrals to law enforcement or for payment recovery based on medical reviews

Required Qualifications, Training, and Education

High School Diploma / GED (or higher)

3+ years of CPT coding experience or 5+ years in fraud investigations

Licensed registered nurse (RN), licensed practical nurse (LPN), or certified coder (CPC, CCS, CPMA)

Thorough knowledge of PC-based software including Microsoft Word and Excel

Preferred : Bachelor's degree or higher