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Healthcare Fraud Shield
Healthcare Fraud Shield
51 – 200 Darbinieki
KonsultācijasVeselības apdrošināšanaVeselības aprūpe
Healthcare Fraud Shield develops payment integrity and cost containment solutions for healthcare insurers. Its AI-driven platform combines anomaly detection with a proprietary data fusion library to identify potential fraud, waste, abuse, and errors in claims. The end-to-end service supports audits before and after payment, bringing claims data together with expert guidance and actionable findings to help insurers improve review accuracy and control costs.
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Vakances uzņēmumā

Remote Coding Auditor – Missouri

Review medical records and claim codes for Healthcare Fraud Shield’s fraud investigations. Support accurate billing, reimbursement, and regulatory compliance.

USAmerikas Savienotās ValstisMOMisūriAttālinātiPilna slodzeJaunākais speciālistsNepieciešamā Valoda: angļuRevidents

Apraksts

  • Review health records against billed ICD-10-CM, CPT, HCPCS, and Revenue codes.
  • Compare claimed procedures and codes with medical records.
  • Assess claim information to identify the amount and nature of billable services.
  • Evaluate whether billing and reimbursement are appropriate.
  • Record findings for each claim line in a spreadsheet.
  • Prepare written summaries of review findings.
  • Extract CPT, HCPCS, Revenue, DRG, and ICD-10 codes from medical records.
  • Keep current with coding guidelines and relevant federal and state regulations.
  • Follow company privacy and security standards.
  • Safeguard confidential health information in accordance with applicable law.
  • Review an average of at least 5–10 claim lines per hour.
  • Carry out other duties as needed.

Prasības

  • Hold a Certified Professional Coder credential.
  • Have at least one year of investigative experience.
  • Hold one of the following credentials: CPC, CCS, or CCA.
  • Know medical terminology.
  • Know coding practices for CPT, HCPCS, Revenue, DRG, and ICD-10 codes.
  • Understand specialty medical practices.
  • Pay close attention to detail.
  • Communicate effectively in writing and verbally.
  • Have strong listening skills.
  • Meet defined performance and productivity targets.
  • Have strong computer skills.
  • Handle confidential and sensitive information discreetly and securely.
  • Have high-speed internet with at least 25 Mbps download and 5 Mbps upload; satellite internet is not accepted.

Priekšrocības

  • Medical, dental, and vision insurance.
  • 401(k) retirement plan with employer match.
  • Paid vacation and sick leave.
  • Seven paid holidays and two floating holidays.
  • Paid maternity and paternity leave.
  • Disability and life insurance.
  • Flexible Spending Account (FSA).
  • Employee Assistance Program (EAP).
  • Professional and career development programs.
  • Eligible to work remotely.

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