SIU Medical & Behavioral Health Coding Analyst
Core
Review medical and behavioral health claims to ensure coding compliance, identify billing fraud/abuse, and validate documentation against state/federal guidelines.
Role type
Senior IC medical coding analyst (SIU)
Builds
Clean, compliant medical claim data for a health insurer/payer
Domain
Healthcare insurance + medical coding compliance
Required skills
Medical coding (CPT/HCPCS/Revenue Codes), CMS guidelines (1500/UB04), fraud detection, documentation auditing, data interpretation
Preferred skills
CPMA certification, CFE or AHFI accreditation, payer environment audit experience
Technologies
Microsoft Excel, Microsoft Word
Responsibilities
Conduct comprehensive medical record reviews for coding accuracy; Identify billing errors, abuse, and fraud patterns; Articulate findings to investigators and legal counsel; Research and apply state/CMS coding policies; Validate decisions with Medical Directors; Maintain audit documentation and files.
Seniority
Mid-level, hands-on IC
