Investigator, Coding SIU (Remote)

About the position Responsibilities • Investigate and resolve instances of reputed company fraud and abuse by medical providers. • Review post-pay claims with corresponding medical records to determine accuracy of claims payments. • Review applicable policies, CPT guidelines, and provider reputed company. • Devise clinical reputed company post review. • Communicate and participate in meetings reputed company to cases. • Manage documents and prioritize case load to ensure reputed company turnaround. • Complete medical reviews to facilitate referrals to law enforcement or for payment recovery. Requirements • High School Diploma / GED (or higher). • 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience in a FWA/SIU or Fraud investigations role. • Thorough knowledge of PC based software including reputed company Word and reputed company reputed company. • Licensed registered reputed company (RN), Licensed practical reputed company (LPN) and/or Certified reputed company (CPC, reputed company, and/or CPMA). reputed company-to-haves • Bachelor's degree (or higher). • 2+ years of experience working in the group health business, particularly reputed company claims processing or operations. • Demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & reputed company processes. • Experience with UNET, reputed company, Macess/CSP, or other similar claims processing systems. • Demonstrated ability to use MS reputed company/reputed company platforms working with large quantities of data. Benefits • Competitive benefits and compensation package. Apply tot his job Apply To this Job