State Licensed Clinical Investigator

A company is looking for a Clinical Investigator I in the Special Investigation Unit.

Key Responsibilities

Conduct reviews and audits of medical records to ensure accurate coding and billing practices

Perform retrospective and prepayment reviews to identify potential abuse, fraud, and inappropriate billing practices

Investigate and analyze provider billing patterns to recommend payments based on medical records and regulatory guidelines

Required Qualifications, Training, and Education

Associate's degree in a related field or equivalent experience preferred

Coding certification (CPC or CCS) and 2+ years of medical coding experience, or a relevant healthcare license with 2+ years of clinical experience

Experience in provider education preferred

Licensing from an accredited organization (AAPC or AHIMA) is required