SIU Clinical Investigator

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

📋 Description

• Collaborate with the SIU team, comprising Clinical Reviewers, CPCs, Investigators, and Analysts; conduct quality checks, support research efforts, and engage in discussions regarding coding decisions.

• Evaluate and analyze patient medical records in relation to investigations of fraud, waste, and abuse.

• Assess claims information to ascertain the nature and extent of billable services.

• Evaluate the appropriateness of billing and reimbursement practices.

• Record findings for each claim line in a spreadsheet format.

• Compile and summarize findings in comprehensive written reports.

• Extract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical documentation.

• Stay updated on coding guidelines and pertinent federal and/or state regulations.

• Conduct data analysis on client information.

• Engage in various components of fraud, waste, and abuse investigations.

• Offer subject matter expertise and SIU assistance to clients.

• Adhere to privacy and security protocols.

• Safeguard and manage protected health information appropriately.

• Undertake additional responsibilities as required.

⛳️ Requirements

• Certified Professional Coder (CPC®) credentialed by the AAPC.

• At least one year of experience in coding and/or billing.

• Familiarity with medical terminology.

• Understanding of CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 coding standards.

• Knowledge of specialty medical practices.

• Strong attention to detail.

• Proficient verbal and written communication skills.

• Excellent listening abilities.

• Self-sufficient, responsible, and disciplined.

• Capability to achieve specified performance and production targets.

• Strong computer proficiency.

• Continuous discretion and secure management of confidential and sensitive information.

• High-speed internet connection with a minimum of 25mbs download and 5mbs upload; satellite internet is not permitted.

🏝️ Benefits

• Medical, Dental & Vision insurance.

• 401(k) retirement plan with employer matching.

• Paid vacation and sick leave.

• 7 paid holidays plus 2 floating holidays.

• Paid maternity and paternity leave.

• Disability and Life insurance options.

• Flexible Spending Account (FSA).

• Employee Assistance Program (EAP).

• Opportunities for professional and career development.

• Eligibility for remote work.

• High-speed internet is mandatory with a minimum of 25mbs download and 5mbs upload; satellite internet is not permitted.