SIU Investigator Healthcare Fraud Shield Not
Position: SIU Investigator Healthcare Fraud Shield Chesterfield, MO Interested Not Interested
Beware of hiring scams where fraudulent actors impersonating our company and employees contact you directly to solicit your job application. Healthcare Fraud Shield will not contact you prior to having received your application.
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 checks on work, assisting in research, and discussing 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 the amount and nature of billable services as needed.
Determine the appropriateness of billing and reimbursement as needed.
Document findings for each claim line in a spreadsheet as needed.
Summarize findings in a written report as needed.
Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed.
Maintain 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.
Understand and comply 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 and 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.
8 paid 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
#J-18808-Ljbffr
Apply Now
Beware of hiring scams where fraudulent actors impersonating our company and employees contact you directly to solicit your job application. Healthcare Fraud Shield will not contact you prior to having received your application.
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 checks on work, assisting in research, and discussing 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 the amount and nature of billable services as needed.
Determine the appropriateness of billing and reimbursement as needed.
Document findings for each claim line in a spreadsheet as needed.
Summarize findings in a written report as needed.
Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed.
Maintain 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.
Understand and comply 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 and 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.
8 paid 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
#J-18808-Ljbffr
Apply Now