SIU Investigator

Beware of hiring scams where fraudulent actors impersonating our company and employees contact you directly to solicit your job application. Healthcare Fraud Shield will not contact you prior to having received your application.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.RESPONSIBILITIESWork 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 neededCompare to information submitted on the claims in order to determine amount and nature of billable services as neededDetermines appropriateness of billing and reimbursement as neededDocuments findings for each claim line in a spreadsheet as neededSummarize findings in a written report as neededAbstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as neededResponsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as neededPerform data analysis and lead generation/data mining of client data as neededConduct various aspects of FWA investigations as neededProvide Subject Matter Expertise and SIU support to clients as neededComply with Privacy and Security standardsUnderstands and complies with all company Privacy and Security standardsEmployee may not use or disclose any protected health information, except as otherwise permitted, or required, by lawOther duties as neededKNOWLEDGE, SKILLS, & ABILITIESKnowledge of medical terminologyKnowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10Knowledge of specialty medical practicesMust be detail orientedAbility to communicate effectively both verbally and in writingStrong listening skillsIndependentResponsibleSelf-disciplinedAbility to meet defined performance and production goalsStrong computer skillsThis job requires access to confidential and sensitive information, requiring ongoing discretion and secure information managementCERTIFICATE/LICENSECertified Professional Coder - (CPC®) through governing body AAPC or equivalent certificationMinimum of one year of coding and/or billing experience is required.BENEFITSMedical, Dental & Vision insurance401(k) retirement savings with employer matchVacation and sick paid time off8 paid holidaysPaid maternity/paternity leaveDisability & Life insuranceFlexible Spending Account (FSA)Employee Assistance Program (EAP)Professional and career development initiativesRemote work eligibleREMOTE WORK REQUIREMENTSMust 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.

Created: 2025-06-03