SIU Clinical Investigator
Healthcare Fraud Shield • Chesterfield, MO15d • Remote
Healthcare Fraud Investigator Jobs
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SIU Clinical Investigator
Healthcare Fraud Shield•Chesterfield, MO
•Remote
About The Position
Healthcare Fraud Shield is seeking a Clinical Coder/Fraud Investigator to join its Special Investigations Unit (SIU). The role involves reviewing medical records and claims in support of fraud, waste, and abuse (FWA) investigations; analyzing coding and billing; documenting and reporting findings; conducting data analysis and investigation activities; and providing subject matter expertise and SIU support to clients. The position requires maintaining current coding and regulatory knowledge and complying with company privacy and security standards when handling protected health information and other sensitive information. The role is remote-work eligible, subject to the stated high-speed internet requirements.
Requirements
- Certified Professional Coder (CPC®) certification through AAPC.
- At least one year of coding and/or billing experience.
- Knowledge of medical terminology.
- Knowledge of coding, including CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10.
- Knowledge of specialty medical practices.
- Attention to detail.
- Effective verbal and written communication skills.
- Strong listening skills.
- Ability to work independently; be responsible and self-disciplined; and meet defined performance and production goals.
- Strong computer skills.
- Discretion and secure information management when accessing confidential and sensitive information.
- For remote work, high-speed internet with at least 25 Mbps download and 5 Mbps upload; satellite internet is not allowed.
Responsibilities
- Work with the SIU team—including clinical reviewers, CPCs, investigators, and analysts—by performing quality checks, assisting with research, and discussing coding determinations as needed.
- Analyze and interpret patient medical records related to FWA investigations.
- Compare claim-submitted information 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 codes from medical records.
- Maintain current knowledge of coding guidelines and relevant federal and state regulations.
- Perform data analysis 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 and applicable requirements for protected health information.
- Perform other duties as needed.
Benefits
- Medical, dental, and vision insurance
- 401(k) retirement savings with employer match
- Paid vacation and sick time
- Seven paid holidays and two floating holidays
- Paid maternity and paternity leave
- Disability and life insurance
- Flexible Spending Account (FSA)
- Employee Assistance Program (EAP)
- Professional and career development initiatives
- Remote work eligible
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
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Frequently Asked Questions
Common questions about Healthcare Fraud Investigator careers and jobs.
Based on current job postings on Teal, the average Healthcare Fraud Investigator salary in the US is approximately $89,000 per year, with a typical range of $60,000 to $105,000.
