Job Description
Beware of hiring scams where fraudulent actors impersonating our company and employees contact you directly to solicit your job application. Healthcare Fraud Shield will not contact you prior to having received your application.
Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented Coder or Clinical Coder/Fraud Investigator to join our team.
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
KNOWLEDGE, SKILLS, & ABILITIES
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
Responsible
Ability to meet defined performance and production goals
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management
CERTIFICATE/LICENSE
Certified Professional Coder - (CPC) through governing body AAPC or equivalent certification
Minimum of one year of coding and/or billing experience is required.
BENEFITS
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
REMOTE WORK REQUIREMENTS
Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Seniority level Seniority level Mid-Senior level
Employment type Employment type Full-time
Job function Job function Health Care Provider
Industries Hospitals and Health Care, Software Development, and Technology, Information and Media
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Job Tags
Full time, Remote work, Flexible hours,