Investigator, Coding SIU (Remote) Job at Idaho State Job Bank, Meridian, ID

SDdaMjZ0MUtDdllmYnMvV3RLaTBGem1GRHc9PQ==
  • Idaho State Job Bank
  • Meridian, ID

Job Description

Investigator, Coding SIU (Remote) at Molina Healthcare in Meridian, Idaho, United States Job Description JOB DESCRIPTION Job Summary The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery. KNOWLEDGE/SKILLS/ABILITIES + Reviews post pay claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider contracts. + Devise clinical summary post review. + Communicate and participate in meetings related to cases. + Critical thinking, problem solving and analytical skills. + Ability to prioritize and manage multiple tasks. + Proven ability to work in a team setting. + Excellent oral and written communication skills and presentation skills. JOB QUALIFICATIONS Required Education High School Diploma / GED (or higher) Required Experience + 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location + Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter) Required License, Certification, Association Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA) Preferred Education Bachelor's degree (or higher) Preferred Experience + 2+ years of experience working in the group health business preferred, particularly within claims processing or operations. + A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.) + Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems. + Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings. Preferred License, Certification, Association + AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional designations preferred To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.82 - $51.06 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. To view full details and how to apply, please login or create a Job Seeker account

Idaho State Job Bank

Job Tags

Remote job, Hourly pay, Contract work, Work experience placement, Local area,

Similar Jobs

Confidential

Chief Lending Officer Job at Confidential

 ...Chief Lending Officer About the Company Esteemed banking firm Industry Banking Type Privately Held About the Role...  ...leadership, managing the internal sales, and partnering with commercial lenders and branch managers. Travel Percent Less than 10... 

Arizona Coalition for Change | Our Voice Our Vote Arizona

Chief of Staff Job at Arizona Coalition for Change | Our Voice Our Vote Arizona

 ...Chief of Staff In 2025, the time for organizing our communities is more important than it has ever been. Our family of organizations Arizona Coalition for Change 501(c)(3) and Our Voice Our Vote Arizona 501(c)(4) is seeking an experienced Chief of Staff who will... 

Slagle Fence

Fencing Subcontractor (Residential & Commercial) Job at Slagle Fence

 ...Job Description Job Description Slagle Fence is looking to add Residential & Commercial Fencing Contractors! Slagle Fence is one of the largest Fence Installers in the Kansas City metro and we are always looking for reliable fence subcontractors. If you are a skilled... 

Headway

Licensed Clinical Social Worker Job at Headway

 ...Remote Licensed Clinical Social Worker (LCSW) Wage: Between $95-$122 an hour Are you a Licensed Clinical Social Worker looking to launch a private practice, or grow your existing practice? Headway can help you earn more through insurance! Headway supports thousands... 

Walt Disney World Resort

CNC Specialist, Walt Disney World Job at Walt Disney World Resort

At Disney, were storytellers. We make the impossible, possible. We do this through utilizing and developing cutting-edge technology and pushing the envelope to bring stories to life through our movies, products, interactive games, parks and resorts, and media networks...