SIU Medical & Behavioral Health Coding Analyst
Core
Conduct comprehensive medical record reviews for the Special Investigations Unit (SIU) to ensure coding compliance, identify billing errors/fraud, and validate claims against state/federal guidelines.
Role type
Senior IC medical coding analyst (fraud investigation)
Builds
Accurate coding compliance reports and fraud detection findings for medical, behavioral, and transportation healthcare providers
Domain
Healthcare compliance and fraud investigation
Required skills
Medical coding (CPT/HCPCS/Revenue Codes), CMS guidelines (1500/UB04), fraud detection, data auditing, written reporting, policy interpretation
Preferred skills
CPMA certification, CFE or AHFI accreditation, payer environment coding experience
Technologies
Microsoft Excel, Microsoft Word
Responsibilities
Review medical records for coding consistency, identify billing abuse/fraud, articulate findings to investigators/legal counsel, research state/CMS guidelines, discuss cases with Medical Directors, maintain case documentation
Seniority
Mid-level, hands-on IC