Certified Coding Investigator (5)

Summary

To support the Special Investigative Unit, the full-time Certified Coding Investigator will investigate and resolve instances of healthcare fraud, waste, and abuse by reviewing medical claims and records while working remotely.Key responsibilitiesIndependently re-evaluates medical claims and associated records for accuracy based on coding standards and regulationsManages documentation and prioritizes caseloads to ensure timely resolution of investigationsCommunicates findings and participates in meetings related to cases, facilitating referrals to law enforcement when necessaryRequired qualificationsAt least 2 years of CPT coding experience in a surgical, hospital, and/or clinic settingCertification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar credentialKnowledge of managed care, Medicaid, Medicare, and Marketplace programsUnderstanding of claim billing codes, medical terminology, and healthcare delivery systemsAbility to research and interpret regulatory requirements effectively

Job Description

To support the Special Investigative Unit, the full-time Certified Coding Investigator will investigate and resolve instances of healthcare fraud, waste, and abuse by reviewing medical claims and records while working remotely.Key responsibilitiesIndependently re-evaluates medical claims and associated records for accuracy based on coding standards and regulationsManages documentation and prioritizes caseloads to ensure timely resolution of investigationsCommunicates findings and participates in meetings related to cases, facilitating referrals to law enforcement when necessaryRequired qualificationsAt least 2 years of CPT coding experience in a surgical, hospital, and/or clinic settingCertification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar credentialKnowledge of managed care, Medicaid, Medicare, and Marketplace programsUnderstanding of claim billing codes, medical terminology, and healthcare delivery systemsAbility to research and interpret regulatory requirements effectively