This is a fully remote position, open to applicants in Missouri.

📋 Description

• Conduct audits of medical records to pinpoint inappropriate billing practices and suggest subsequent actions through thorough examination of claims data, medical records, corporate policy, state/federal regulations, and practice standards.

• Execute retrospective and prepayment reviews of medical records to uncover potential fraud and abuse, as well as inappropriate billing practices.

• Investigate, analyze, and discern provider billing patterns to recommend payment based on medical records, claim histories, billing codes, regulatory frameworks, and state policies.

• Compile a summary of findings and propose next steps for providers.

• Identify preventative strategies and suggest modifications to internal policies and procedures, and/or provider practices to avert future fraudulent and erroneous actions.

• Collaborate with investigators to uncover abuse and fraud by leveraging clinical and coding expertise to scrutinize billing activity patterns.

• Fulfill other assigned responsibilities.

• Adhere to all policies and standards.

⛳️ Requirements

• Associate's Degree in a related field or equivalent experience is preferred.

• A minimum of 2 years of relevant clinical experience in the field associated with the obtained license is required.

• Provider education experience is preferred.

• Coding certification from a recognized organization (such as the American Academy of Professional Coders or American Health Information Management Association), RN, LPC, LPN, LCSW, LMHC, PT, OT, or ST, or a related license is required.

• Preferred qualifications include coding certification, experience in nurse coding, and familiarity with CPT coding.