SIU Clinical Investigator
医疗保健欺诈盾，是医疗保健预防和支付完整性解决方案的领导者，正在寻找一个有才华的临床编码/欺诈调查员加入我们的团队。关键责任 · 与 SIU 团队合作 （临床审查人员，CPCs,调查人员，分析师-包括在工作上进行质量检查，协助研究，根据需要讨论适当的编码确定）. ·根据需要分析和解释有关 FWA 调查的患者医学记录。·将提交的索赔信息进行比较以确定可收费服务的数额和性质。·根据需要决定结算和退款是否合适。· 根据需要，在电子表格中记录每个索赔行的发现。· 如需总结书面报告中的发现。· 从医疗档案中摘要 CPT,HCPCS,收入代码，DRG 代码和 ICD-9/ICD-10. · 根据必要性保持对编码指南和相关联邦或州法规的当前知识。· 按照需要进行客户数据分析。· 根据需求开展 FWA 调查的各种方面。· 提供专业知识和 SIU 支持给客户。· 遵守隐私与安全标准。· 了解并符合所有公司隐私和安全标准。· 员工不得使用或披露任何保护的健康信息，除非法律允许或要求。· 其他义务如有必要。技能，知识和专业知识 · 医学术语知识。· 包括 CPT,HCPCS,收入代码，DRG 代码和 ICD-10在内的编程知识。· 专业医疗实践知识。·必须以细节为导向。· 语言和书面有效沟通能力。· 强大的倾听技巧。· 自主。· 负责人。· 自律。· 实现定义的性能和生产目标的能力。· 较强的计算机技能。· 需要获得机密和敏感信息，需要持续的自由裁量和安全信息管理。证书/许可证：·经由主管机构 AAPC 授予的认证专业编码器 (CPC®). ·需至少有一年的编程和/或发票经验。福利 ·医疗保险，牙科&视觉保险 · 401k) 与雇主匹配的退休储蓄 ·假期和病人的付费放假 · 7个有偿假期 & 2个浮动假期 · 有偿产妇/父亲假期 ·残疾 & 生活保险 ·灵活的斯宾恩·
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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:
- Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
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.
Originally posted on Himalayas