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Healthcare Fraud Shield
Healthcare Fraud Shield
51 – 200 Angajați
Asigurare de sănătateAsistență medicalăConsultanță
Healthcare Fraud Shield dezvoltă soluții pentru integritatea plăților și controlul costurilor destinate asigurătorilor de sănătate. Platforma sa bazată pe inteligență artificială combină detectarea anomaliilor cu o bibliotecă proprietară de fuziune a datelor pentru a identifica potențiale fraude, risipă, abuzuri și erori în dosarele de daună. Serviciul complet susține audituri înainte și după plată, reunind datele cererilor de despăgubire cu îndrumarea experților și constatări concrete, pentru a-i ajuta pe asigurători să îmbunătățească precizia evaluării și să controleze costurile.
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Locurile de muncă ale companiei

Remote Coding Auditor – Missouri

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

USStatele Unite ale AmericiiMOMissouriRemoteNormă întreagăJuniorLimbă Obligatorie: englezăAuditor

Descriere

  • 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.

Cerințe

  • 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.

Beneficii

  • 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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