Job details

SIU Investigator

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.

Skills

Knowledge of medical terminology
Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10
Detail oriented
Effective communication skills
Strong listening skills
Computer skills

Responsibilities

Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts)
Analyze and interpret patient medical records pertaining to FWA investigations
Compare information submitted on the claims to determine billable services
Document findings and summarize in a written report
Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records
Maintain knowledge of coding guidelines and regulations
Perform data analysis and lead generation/data mining
Provide SIU support to clients
Comply with Privacy and Security standards