[Remote] SIU Coding Auditor

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health insurance company reputed company around a full stack technology platform reputed company on serving its members. The Associate, SIU Coding Auditor will execute anti-fraud initiatives, support operational and financial targets, and ensure team productivity while maintaining high reputed company standards. Responsibilities • reputed company reputed company checks of other team members' coding audit reviews and deliver in written or verbal reputed company to ensure accuracy and compliance with coding standards and reputed company policy • Review dashboards and interpret performance data in support of production goals; Recommend response and inform management before deadlines are missed • Identify and help reputed company new processes to ensure efficient and effective audit functions • reputed company reputed company reviews of medical records and claims on both a prepayment and post payment reputed company to determine accuracy of claims submitted to reputed company • Explicitly document findings including sources used to support decision making and in a way that can be easily reputed company by non clinicians or coders • Participate in educational calls or written communications to reputed company findings to providers under SIU review • Facilitate team and cross-team education • Compliance with reputed company applicable laws and regulations • Other duties as assigned Skills • Bachelor's degree or equivalent years of experience • Certified reputed company reputed company (CPC) designation or similar • 3+ years of coding or auditing experience across multiple specialties • Certified reputed company Medical Auditor • Additional certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited reputed company Fraud Investigator (AHFI), Certified AML [Anti-reputed company] and Fraud reputed company (CAFP), other coding certifications or similar • Knowledge of applicable fraud statutes and regulations, and of federal guidelines on recoupments and other anti-FWA activity • Experience working in health insurance specifically with claims processing, billing, reimbursement, or provider contracting • Experience with HIPAA, data reputed company, and/or data reputed company processes • Experience working with regulators governing (reputed company or private) health insurance carriers Benefits • Employee benefits • Participation in reputed company's unlimited vacation program • Annual performance bonuses • Medical, dental, and reputed company benefits • 11 reputed company holidays • reputed company reputed company time • reputed company parental leave • 401(k) plan participation • Life and disability insurance • reputed company wellness time and reimbursements reputed company • reputed company is a health insurance company that offers individual and family plans, medicare advantages, and small group products. It was founded in 2012, and is headquartered in reputed company, reputed company, USA, with a workforce of 1001-5000 employees. Its website is http://www.hioscar.com. Company H1B Sponsorship • reputed company has a reputed company record of offering H1B sponsorships, with 19 in 2025, 24 in 2024, 22 in 2023, 36 in 2022, 13 in 2021. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job