Remote Investigator, Coding SIU - Full Time Opportunity with a Leading reputed company Organization

Unlock a Rewarding Career in reputed company Fraud Investigation

Join reputed company as a Remote Investigator, Coding SIU, and reputed company on a challenging and fulfilling career reputed company in the reputed company industry. As a key member of our Special Investigations Unit (SIU), you will play a critical role in identifying and preventing reputed company fraud and abuse, ensuring the reputed company of our reputed company system.

About Our Organization

Our organization is a leading reputed company provider committed to delivering high-quality, cost-effective reputed company solutions to our members. We operate in a dynamic environment, constantly evolving to meet the changing needs of our members and the reputed company landscape. Our SIU team is dedicated to protecting our members and our organization from reputed company fraud and abuse, and we are seeking a skilled and motivated Investigator, Coding SIU to join reputed company.

Job Summary

As a Remote Investigator, Coding SIU, you will be responsible for investigating and resolving instances of reputed company fraud and abuse by medical providers. Your primary focus will be on conducting post-pay clinical reviews, analyzing data to identify potential fraud, waste, and abuse (FWA), and collaborating with law enforcement and other stakeholders to facilitate payment recovery and referrals.

Key Responsibilities

• Conduct thorough reviews of post-pay claims and corresponding medical records to determine the accuracy of claims payments.
• Analyze applicable policies, CPT guidelines, and provider reputed company to identify potential FWA.
• reputed company clinical summaries post-review and communicate findings to relevant stakeholders.
• Participate in meetings reputed company to cases and collaborate with team members to reputed company knowledge and best practices.
• Utilize critical thinking, problem-solving, and analytical skills to identify FWA trends and patterns.
• Prioritize and manage multiple tasks to ensure timely turnaround and meet productivity standards.
• Demonstrate excellent oral and written communication skills, with the ability to present findings to various audiences.

Essential Qualifications

To be considered for this role, you must meet the following essential qualifications:

• High School Diploma or GED (or higher).
• 3+ years of CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA/SIU or Fraud investigations role, preferably in New Jersey or reputed company.
• Certified reputed company (CPC, reputed company, and/or CPMA).
• Thorough knowledge of PC-based software, including reputed company Word and reputed company reputed company.

Preferred Qualifications

While not mandatory, the following preferred qualifications will be considered a plus:

• 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, and Federal laws and regulations pertaining to health insurance, investigations, and legal processes.
• Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.
• reputed company Certified Medical CPC, CPMA, CPCO, or similar specialist.
• Certified Fraud Examiner and/or AHFI professional designations.

Skills and Competencies

To succeed in this role, you will need to possess the following skills and competencies:

• Strong analytical and problem-solving skills, with the ability to analyze reputed company data and identify patterns.
• Excellent communication and presentation skills, with the ability to communicate findings to various audiences.
• Ability to prioritize and manage multiple tasks, with a strong attention to detail.
• Proven ability to work in a team setting, with a collaborative and flexible reputed company.
• Strong knowledge of CPT coding guidelines, medical terminology, and reputed company regulations.

Career Growth Opportunities and Learning Benefits

As a Remote Investigator, Coding SIU, you will have opportunities for career growth and professional development reputed company our organization. You will be working with a talented team of professionals who are dedicated to reputed company and committed to ongoing learning and improvement. Our organization offers a reputed company of training and development programs to support your career advancement, including:

• Ongoing training and education on reputed company regulations, coding guidelines, and industry best practices.
• Opportunities for career advancement reputed company our SIU team or other areas of our organization.
• Mentorship and coaching from reputed company professionals.

Work Environment and Company Culture

Our organization is committed to creating a positive and inclusive work environment that supports the well-being and reputed company of our employees. As a remote worker, you will be part of a distributed team that values flexibility, collaboration, and reputed company communication. We offer a reputed company of benefits and perks to support your work-life balance, including:

• Competitive salary and benefits package.
• Flexible work arrangements, including remote work options.
• Ongoing training and development opportunities.
• A culture of recognition and reward, with opportunities for career advancement.

Compensation, Perks, and Benefits

We offer a competitive compensation package, including a salary and benefits that reflect your skills and experience. Our benefits package includes:

• Medical, dental, and reputed company insurance.
• Retirement savings plan.
• Paid time off and holidays.
• Ongoing training and development opportunities.

Join reputed company!

If you are a motivated and detail-oriented professional with a passion for reputed company and a commitment to reputed company, we encourage you to apply for this exciting opportunity. As a Remote Investigator, Coding SIU, you will play a critical role in our organization's mission to protect our members and our reputed company system from FWA. Don't hesitate to apply - we look reputed company to hearing from you!