SIU Investigator

🔥 6 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟢 Junior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, including behavioral-related records and other specialties, for FWA investigations • Compare medical records with submitted claims to determine the amount and nature of billable services • Determine the 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 and lead generation/data mining of client data • Conduct various aspects of FWA investigations • Provide subject matter expertise and SIU support to clients • Comply with company privacy and security standards • Protect and appropriately handle protected health information • Perform other duties as needed

🎯 Requirements

• 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. • Must have high-speed internet with minimum 25 Mbps download and 5 Mbps 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 • Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.