Special Investigations Unit (SIU) Certified Professional reputed company (Fully Remote)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary The Certified Professional 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. Activities Include • Conduct a comprehensive medical record review to ensure billing is consistent with medical record. • reputed company detailed written summary of medical record review findings. • Must be reputed company to reputed company findings to investigators, reputed company plan leadership, law enforcement, legal 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 Required Qualifications • reputed company Coding certification - Certified Professional reputed company (CPC) • 3+ years of experience in medical coding or documentation auditing. • Strong knowledge of standard industry coding guides and guidelines including CPT, HCPCS, ICD-10, CMS 1500 and UB04 data elements • Experience with researching coding, state regulations and policies. • Working experience with reputed company reputed company • Strong attention to detail and ability to review and interpret data • Excellent communication skills Preferred Qualifications • 2 years or more previous experience with Behavioral Health coding/auditing of records • Licensed Clinical reputed company Worker (LCSW) • Licensed Independent reputed company Worker (LISW) • Licensed Master reputed company Worker (LMSW) • Prior auditing experience • Excellent analytical skills Education • reputed company Certified Professional reputed company Certification (CPC) Pay reputed company The Typical Pay reputed company For This Role Is $43,888.00 - $102,081.60 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 12/06/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!