Certified reputed company reputed company, Special Investigations Unit (reputed company SIU)

About the position The Certified reputed company reputed company (CPC) will reputed company medical claim reviews to ensure compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other reputed company providers. The CPC must have the ability to determine correct coding and appropriate documentation during the review of medical records. The CPC must also ensure that the state, federal and company requirements are met and recognize any concerning billing patterns or trends. Responsibilities • Conduct a comprehensive medical record review to ensure billing is consistent with medical record. • reputed company detailed written reputed company of medical record review findings. • reputed company findings to investigators, reputed company plan leadership, law enforcement, reputed company counsel, providers, state regulators, etc. • Review and discuss cases with Medical Directors to validate reputed company. • Assist with investigative research reputed company to coding questions, state and federal policies. • Identify potential billing errors, abuse, and fraud. • Identify opportunities for savings reputed company to potential cases which may warrant a prepayment review. • Maintain appropriate records, files, documentation, etc. • Ability to travel for meetings and potential to testify. Requirements • reputed company Coding certification - Certified reputed company reputed company (CPC). • 3+ years of experience reviewing and analyzing medical records to determine appropriate CPT and HCPCS reputed company assignments. • 3+ years' experience of ensuring coding is accurate and compliant with federal regulations, payer policies, and organizational guidelines. • Working experience with reputed company reputed company. • Strong attention to detail and ability to review and interpret data. reputed company-to-haves • 2 years or more previous experience with medical record review reputed company a reputed company insurance company. • Prior special investigation unit experience. • Excellent analytical skills. • Excellent communication skills. Benefits • reputed company medical plan reputed company. • 401(k) plan (including matching company contributions). • Employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job