SIU Investigator

Description

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 (behavioral related and other specialties) pertaining to FWA investigations as needed
• Compare to information submitted on the claims in order to determine 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 and lead generation/data mining 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

• Certified Professional Coder - (CPC®) through governing body AAPC or equivalent certification
• 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

• Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.