SIU Clinical Investigator

🔥 1 minute ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

👻 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

• Work with the SIU team, including Clinical Reviewers, CPCs, Investigators, and Analysts; perform quality checks, assist with research, and discuss coding determinations • Analyze and interpret patient medical records for fraud, waste, and abuse investigations • Compare claims information to determine the amount and nature of billable services • Determine appropriateness of billing and reimbursement • Document findings for each claim line in a spreadsheet • Summarize findings in written reports • Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records • Maintain current knowledge of coding guidelines and relevant federal and/or state regulations • Perform data analysis of client data • Conduct various aspects of fraud, waste, and abuse investigations • Provide subject matter expertise and SIU support to clients • Comply with privacy and security standards • Protect and properly handle protected health information • Perform other duties as needed

🎯 Requirements

• Certified Professional Coder (CPC®) through governing body AAPC • Minimum of one year of coding and/or billing experience • Knowledge of medical terminology • Knowledge of CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 coding • Knowledge of specialty medical practices • Detail-oriented • Effective verbal and written communication • Strong listening skills • Independent, responsible, and self-disciplined • Ability to meet defined performance and production goals • Strong computer skills • Ongoing discretion and secure information management for confidential and sensitive information • 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 with minimum 25mbs download and 5mbs upload; satellite Internet is not allowed