SIU Investigator

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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.

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

KNOWLEDGE, SKILLS, & ABILITIES

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

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

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

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.

Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.