SIU Investigator

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

📋 Description

• Collaborate with the SIU Team, which includes Clinical Reviewers, CPCs, Investigators, and Analysts; carry out quality checks, assist with research, and engage in discussions regarding coding determinations.

• Evaluate and interpret patient medical records, encompassing behavioral-related records and other specialties, for FWA investigations.

• Cross-reference medical records against submitted claims to ascertain the quantity and nature of billable services.

• Assess the validity of billing and reimbursement processes.

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

• Compile findings into 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 and lead generation/data mining on client data.

• Execute various components of FWA investigations.

• Offer subject matter expertise and SIU support to clients.

• Adhere to company privacy and security protocols.

• Safeguard and appropriately manage protected health information.

• Undertake additional duties as necessary.

⛳️ Requirements

• Proficient understanding of medical terminology.

• Familiarity with coding systems including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.

• Knowledge of various specialty medical practices.

• Must exhibit attention to detail.

• Capability to communicate effectively both verbally and in writing.

• Strong listening abilities.

• Ability to work independently.

• Responsible and self-disciplined.

• Competence in meeting established performance and production objectives.

• Robust computer skills.

• This position necessitates access to confidential and sensitive information, requiring continuous discretion and secure information management.

• Certified Professional Coder (CPC®) designation from the AAPC or an equivalent certification.

• A minimum of one year of coding and/or billing experience is mandatory.

• High-speed internet access is required, with a minimum of 25 Mbps download and 5 Mbps upload; satellite internet is not permitted.

🏝️ Benefits

• Medical, Dental & Vision insurance.

• 401(k) retirement savings plan with employer match.

• Paid vacation and sick leave.

• 7 paid holidays and 2 floating holidays.

• Paid maternity/paternity leave.

• Disability and Life insurance.

• Flexible Spending Account (FSA).

• Employee Assistance Program (EAP).

• Opportunities for professional and career development.

• Eligible for remote work.

• High-speed Internet is required (satellite is prohibited for this role) with a minimum speed of 25 Mbps download and 5 Mbps upload.