SIU Analyst

🔥 13 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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Healthcare Fraud Shield

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-01

Healthcare • Consulting • Healthcare Insurance

Healthcare Fraud Shield is a company specializing in Payment Integrity and Cost Containment solutions for healthcare insurers. They offer a comprehensive, AI-driven platform that incorporates advanced anomaly detection and a proprietary data fusion library to combat fraud, waste, abuse, and errors in healthcare claims. Their robust end-to-end solution optimizes the auditing process, utilizing both pre- and post-payment data to maximize savings and improve accuracy in claim processing. By providing actionable insights and expert support, Healthcare Fraud Shield helps organizations achieve significant annual savings and enhance operational efficiency.

📋 Description

• Assist and support the SIU team, including Managers, Clinical Reviewers, CPCs, Investigators, and Analysts, with daily tasks • Help with intake and triage of client-assigned tasks • Assist in analyzing patient medical records for fraud, waste, and abuse investigations • Support comparison of medical records with claim information to determine billable services • Document findings for each claim line in a spreadsheet • Contribute to written reports summarizing findings • Assist with abstracting CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records • Support maintaining current knowledge of coding guidelines and regulations • Assist with client data analysis • Provide basic support for various aspects of fraud, waste, and abuse investigations • Comply with and follow company Privacy and Security standards • Respect and protect confidential and sensitive information, including protected health information • Perform other duties as assigned

🎯 Requirements

• Basic knowledge of medical terminology • Basic knowledge of coding concepts, including CPT, HCPCS, and ICD-10 • Basic knowledge of specialty medical practices • Attention to detail • Ability to communicate clearly and effectively, both verbally and in writing • Good listening skills • Ability to work both independently and as part of a team • Responsible and self-disciplined • Ability to meet defined performance and production goals • Basic computer skills • Discretion and secure information management when accessing confidential and sensitive information, including protected health information • Healthcare knowledge and a strong interest in medical claims, coding, and investigations are a plus • High-speed Internet with minimum 25mbs download and 5mbs upload; satellite Internet is not allowed

🏖️ Benefits

• 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 • High-speed Internet required (minimum 25mbs download and 5mbs upload; satellite is not allowed)

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