Special Investigations Unit Medical Reviewer
Job in
Rancho Cucamonga, San Bernardino County, California, 91739, USA
Listed on 2025-12-02
Listing for:
IEHP
Full Time
position Listed on 2025-12-02
Job specializations:
-
Healthcare
Healthcare Administration, Medical Billing and Coding, Healthcare Compliance
Job Description & How to Apply Below
Special Investigations Unit Medical Reviewer
Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed. The review identifies coding errors and billing discrepancies related to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP’s Compliance Special Investigations Unit.
Perks- Competitive salary
- Hybrid schedule
- State‑of‑the‑art fitness center on‑site
- Medical Insurance with Dental and Vision
- Life, short‑term, and long‑term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work‑life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
- Minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting
- Bachelor’s degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or related field from an accredited institution required
- In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required; this experience is in addition to the minimum years listed above
- Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) required
- One of the following licenses preferred:
- Licensed Vocational Nurse (LVN) active, unrestricted, and unencumbered issued by the California Board of Vocational Nursing and Psychiatric Technicians
- Licensed Registered Nurse (RN) active, unrestricted, and unencumbered issued by the California BRN
- Valid California Driver’s license
- Strong understanding of medical coding, billing practices, and healthcare regulations
- Thorough understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC’s and other guidelines; general understanding of investigative processes within a healthcare environment required
- Knowledge of Medi‑Cal and Medicare rules and regulations, and managed care in California preferred
- Strong verbal and written communication, interpersonal skills, critical problem‑solving skills, and attention to detail
- Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary
- Detail‑oriented with strong organizational and time‑management abilities; ability to articulate medical review findings clearly and thoroughly
- Conduct research in support of medical reviews and make determinations on claims with a high level of accuracy
- Demonstrated ability to interpret and analyze healthcare data and records
- Adapt to different technology software and platforms, including anti‑fraud solutions
- Ability to work independently and collaboratively with a team
- $71,572.80 USD Annually – $93,038.40 USD Annually
To View & Apply for jobs on this site that accept applications from your location or country, tap the button below to make a Search.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).
Search for further Jobs Here:
×