SIU Investigator

SIU Investigator

Department: SIU

Employment Type: Full Time

Location: Headquarters

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.

• 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 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

• Certified Professional Coder - (CPC®) through governing body AAPC or equivalent certification
• Minimum of one year of coding and/or billing experience is required.

• 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

• 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.