Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Clinical Coder/Fraud Investigator to join our team.Key Responsibilities
Work with SIU Team (Clinical Reviewers, CPCs, Investigators, Analysts-including performing quality check on work, assisting in research, discuss to make appropriate coding determinations as needed).
Analyze and interpret patient medical records pertaining to FWA investigations as needed.
Compare information submitted on the claims to determine the amount and nature of billable services as needed.
Determines appropriateness of billing and reimbursement as needed.
Documents findings for each claim line in a spreadsheet as needed.
Summarize findings in a written report as needed.
Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records as needed.
Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed.
Perform data analysis of client data as needed.
Conduct various aspects of FWA investigations as needed.
Provide Subject Matter Expertise and SIU support to clients as needed.
Comply with Privacy and Security standards.
Understands and complies with all company Privacy and Security standards.
Employee may not use or disclose any protected health information, except as otherwise permitted, or required, by law.
Other duties as needed.
Skills, Knowledge and Expertise
Knowledge of medical terminology.
Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10.
Knowledge of specialty medical practices.
Must be detail-oriented.
Ability to communicate effectively both verbally and in writing.
Strong listening skills.
Independent.
Responsible.
Self-disciplined.
Ability to meet defined performance and production goals.
Strong computer skills.
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Certificate/License:
Certified Professional Coder - (CPC®) through governing body AAPC.
Minimum of one year of coding and/or billing experience is required.
Benefits
Medical, Dental & Vision insurance
401(k) retirement savings with employer match
Vacation and sick paid time off
7 paid holidays & 2 floating holidays
Paid maternity/paternity leave
Disability & Life insurance
Flexible Spending Account (FSA)
Employee Assistance Program (EAP)
Professional and career development initiatives
Remote work eligible
REMOTE WORK REQUIREMENTS:
Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Healthcare Fraud Shield is a leader in healthcare fraud prevention and payment integrity solutions. The company specializes in fraud, waste, and abuse (FWA) investigations within the healthcare industry, providing specialized clinical coding review and fraud investigation services. Their solutions involve analyzing medical records, comparing claim submissions against billable services, and determining the appropriateness of billing and reimbursement. Healthcare Fraud Shield supports clients through their Special Investigations Unit (SIU) team, which includes clinical reviewers, certified coders, investigators, and analysts who work collaboratively to identify and document healthcare fraud.
