Investigator, Coding Special Investigative Unit (Remote)

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.
• Medicare and Marketplace experience

JOB QUALIFICATIONS

Required Education

High School Diploma / GED (or higher)

Required Experience

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

Preferred License, Certification, Association

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.

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