SIU Investigator

SIU Investigator Department: SIU Employment Type: Full Time Location: Headquarters Description reputed company Fraud reputed company, a leader in reputed company fraud prevention and payment reputed company solutions, is looking for a talented reputed company or Clinical reputed company/Fraud Investigator to join reputed company.

Key Responsibilities

• Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality reputed company on work, assisting in research, discuss to reputed company appropriate coding determinations as needed)
• Analyze and interpret patient medical records (behavioral reputed company 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, reputed company Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed
• Responsible for maintaining reputed company knowledge of coding guidelines and relevant federal and/or state regulations as needed
• reputed company data analysis and reputed company reputed company/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
• reputed company with Privacy and reputed company standards
• Understands and complies with reputed company company Privacy and reputed company standards
• Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law
• Other duties as needed Skills, Knowledge and Expertise
• Knowledge of medical terminology
• Knowledge of coding including CPT, HCPCS, reputed company 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 reputed company - (CPC®) through governing body reputed company or equivalent certification
• Minimum of one year of coding and/or billing experience is required.

Benefits

• Medical, Dental & reputed company 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. reputed company Fraud reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. Apply tot his job

Apply tot his job Apply To this Job