Remote Clinical Investigator: Medical Coding & Claims
Optum
Minneapolis, MN
- Remote job
Optum is seeking a skilled M&R Clinical Investigator to verify claims against medical records. You will review CPT/HCPCS/ICD codes, ensure compliant coding, and support pre-payment decisions in a telecommuting setup across the United States, with strong collaboration across teams. You will analyze clinical data, interpret policies, and communicate findings clearly to providers. The role emphasizes chart reviews, fraud/waste detection, and adherence to regulatory guidelines in a flexible #J-18808-Ljbffr Optum
Vacancy posted 21 hours ago
Similar jobs that could be interesting for youBased on the Remote Clinical Investigator: Medical Coding & Claims in Minneapolis, MN vacancy
$24 - $43 per hour
...M&R Coding Clinical Analyst Optum is a global organization... ...the accuracy of claims submitted by a provider... ...by comparing it to the medical record(s) submitted for... ...They are responsible to investigate, review and provide clinical... ...on complex cases. Remote: You'll enjoy the...Remote jobClaimsHourly payMinimum wageFull timeContract workWork experience placementLocal area$56.2k - $101k
...comprehensive reviews of medical records and documents supporting claims for providers,... ..., etc. Provides investigative support to the... ...(SIU) related to coding and billing issues... ...Details This is a remote position. Candidates... ...fraud by utilizing clinical and coding expertise...Remote workClaimsFull timePart timeWork at officeFlexible hours$32.03 - $45.7 per hour
...Associate Fraud and Abuse Investigator/Certified Professional Coder (CPC) Remote! Status: Full-... ...hospital based coding in routine desk... ...health insurance claims processing and ensures... ...required in Medical Coding OR Healthcare... ...programs, and integrated clinical and behavioral...Remote workClaimsHourly payPermanent employmentFull timeTemporary workLive inCurrently hiringWork at officeShift workSentara Health
Norfolk, VA3 hours ago$46.99k - $102k
...Senior Investigator We're building a world of health around every... ...prevent payment of fraudulent claims submitted to the Medicaid... ...Researches and prepares cases for clinical and legal review... ...matters. ~ Working knowledge of medical coding; CPT, HCPCS, ICD10 ~ Experience...Remote workClaimsHourly payFull timeWork at officeLocal areaOak St. Health
United States2 days ago- UnitedHealth Group is seeking a M&R Clinical Investigator to verify claim accuracy by comparing provider medical records to submitted claims. The role supports pre-payment... ...reviews in a telecommuting setup, requiring coding expertise and healthcare regulatory knowledge....Remote jobClaims
- ...Provides support for special investigation unit (SIU) activities specific to medical provider coding fraud, waste and abuse (FWA).... ...following review of post-payment claims. Essential Job Duties... ...contract requirements. Devises clinical summary post-review. Communicates...Remote jobClaimsContract workWork at officeLocal area
$56.2k - $101k
...Fraud, Waste, and Abuse Investigator Position Purpose: Conduct... ...investigations by reviewing referrals, claims data, medical records, provider... ...medical records, billing and coding documentation, provider... ...flexible approach to work with remote, hybrid, field or office...Remote workClaimsFull timePart timeH1bWork at officeFlexible hoursCentene Corporation
United States2 days ago$75.58k - $93.37k
...Summary The SIU Investigator looks into suspected... ...data analysis, medical record review, interviews... ...internal departments (Claims, Compliance, Payment Integrity... ...HCPCS, and ICD-10-CM coding guidelines... ...Determinations Coordinates clinical and coding review as needed...Remote workClaimsFull timeFor contractorsWork at officeLocal area$60.1k - $98.7k
...of inpatient care and a passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgment to review medical records,...Remote workClaimsFull time- ...Health Plan (PCHP) Special Investigations Unit is to implement an... ...and abuse violations. The Clinical SIU Investigator ensures PCHP... ...care organization or medical record auditing is preferred... ...based on medical records, claim history, billing codes, regulatory and state guidelines...ClaimsWork at office
Parkland Health and Hospital System
Dallas, TX5 days ago - ...The Senior Clinical Coder serves as a subject matter expert in medical coding and DRG validation, playing a... ...detailed retrospective claims reviews, provide expert... ...in a fast-paced, remote environment and is passionate... ...favorable background investigation Desired...Remote workClaimsFull timeWork at officeWork from homeHome office
TEEMA Group
Tallahassee, FL5 days ago - ...Summary : The Coder (Clinic - II) performs coding review for primary care or... ...regulatory requirements. Audits medical record documentation for... ...between 7:00am-5:00pm CT ~ REMOTE position KEY ACCOUNTABILITIES... ...to payer denials and claim edits to ensure timely...Remote workClaimsFull timeWork at officeFlexible hoursShift work
- ...looking for a talented Clinical Coder/Fraud Investigator to join our team.... ...to make appropriate coding determinations as needed... ...interpret patient medical records pertaining... ...information submitted on the claims to determine the... ...initiatives ~ Remote work eligible...Remote workClaimsFlexible hours
- ...APWU Health Plan is seeking a FWA Clinical Investigator to join our Finance and... ...clinical documentation and healthcare claims to identify billing irregularities, coding inaccuracies, and suspicious... ...Accountabilities: Review electronic medical records (EMRs), clinical notes,...ClaimsWork at office
- ...Job Title Clinical Analyst & Coding Specialist Location Columbia, SC Hybrid (80% remote, onsite for required trainings and meetings... ...Subject Matter Expert (SME) for medical coding, Medicaid policy, and... ...policy remediation. Claims processing systems experience...Remote workClaimsContract workWork at office
- ...down healthcare costs. The Medical Review Audit Supervisor is a... ...working supervisor who leads a remote team of clinical auditors performing medical... ...a limited volume of SNF claim reviews; serve as technical... ...daily skilled services, and MDS coding accuracy to ensure findings...Remote workClaimsFull timeFor subcontractorWork at office
$28 - $30 per hour
...Remote Clinical Quality Improvement Coordinator Guidehealth is a data-... ...methods of data sourcing-EMR, claims, provider outreach. Manage... ...lists, sourced health data and medical records in your daily work.... ...NCQA/HEDIS® specifications, coding documents, quick reference guides...Remote workClaimsBi-weekly payHourly payFull timeTemporary workFor contractorsLocal areaWork from homeFlexible hoursGuidehealth
United States5 days ago- ...Network is looking for a Coding Specialist to join our... ...This full time hybrid remote position will support our... ..., performs all medical record coding activities... ...and abstracts relevant clinical and demographic information... ...issues that may impact claim accuracy or payment. Maintains...Remote workClaimsFull timeLive inWork at officeMonday to Friday
- Clinical & Health Specialist Remote Role Role/Domain | Exp | Geo Utilization Management... ...Patient Safety Nurse| 8y Medical Coder / CDI | 3y Clinical... ...Authorization, and Payer Claims Dietetics, Nutrition, Diabetes... ..., and EVS Policy Medical Coding, CDI, Billing, and Denials...Remote workClaimsFull timePart timeFor contractors
$65.89k - $98.83k
...MSHP seeks a Clinical Documentation Specialist who will... ...documentation and coding in outpatient physician... ...review and code ambulatory medical records, identify... ...service levels prior to claim submission to ensure... ...research dollars per investigator according to the Association...Remote workClaimsFull timeTraineeshipWork at officeLocal area- ...Payment Integrity Drg Coding & Clinical Validation Analyst The Payment... ...is responsible for reviewing medical records for appropriate provider... ...and audits acute inpatient claims. Integrates medical chart... ...There may be opportunity for remote work within all jobs posted...Remote workClaimsWork experience placement
$18 - $26 per hour
...monitoring tools and virtual clinical programs. Monovo exists to make... ...revenue cycle management, medical coding, billing workflows, and documentation... ...coding, billing, and claim‑related workflows. Apply or... ...documentation review. Familiarity with remote patient monitoring, chronic...Remote workClaimsHourly payFull timePart timeWork at officeMonday to Friday$90.34k - $109.03k
...Senior Clinical Documentation Integrity (CDI) & Coding Specialist The Senior Clinical Documentation... ...to support HEDIS medical record retrieval and abstraction... ...capabilities. This is a remote role, MondayFriday, 8:00... ...in available clinical or claims data. Evaluate coding...Remote workClaimsTemporary workImmediate startRotating shift$45.67 per hour
Title Auditor Clinical Validation Outpatient Specialty Clinical Location Remote, United States Department Audit... ...role will focus on Coding & Clinical Chart Validation... ...outpatient/specialty claims and documenting the... ...review, coding accuracy, medical necessity, and the...Remote workClaimsHourly payFull timeContract workWork at officeLocal area- ...Optum Waste and Error Claims Investigator Optum is a global organization... ...Primary Responsibilities: Clinical Case Reviews - 75% Perform... ...professional (or facility) claims vs. medical records to determine if the... ...- 10% Keep up required Coding Certificate and/or Nursing...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
$29 - $52 per hour
...Growing together. The Clinical Claim Review RN will be... ...reviews of medical and administrative documentation... ..., and confidential investigations in order to document... ...This position is Remote in Massachusetts. You... ...terminology and claim coding with familiarity of CPT...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift workUnitedHealth Group
Boston, MA3 days ago- ...Role Overview: The Investigator is responsible for conducting comprehensive... ...). Work Arrangement: ~ Remote within the United States.... ..., etc., to analyze aberrant claims billing and practice patterns... ...knowledge required. Clinical Experience preferred. SIU...Remote workClaimsContract workWork experience placementLocal areaFlexible hours
AmeriHealth Caritas
Newtown Square, PA1 day ago - Medix is seeking an RN-Coder Clinical Validation Reviewer to support payment integrity... ...setup. The role emphasizes reviewing medical records against claims to determine support for billed... ...documentation of clear clinical and coding rationales. Ideal candidates are active...Remote jobClaimsWork at office
- Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools to... ...accurate reimbursements. The role supports remote work from anywhere in the U.S. and...Remote jobClaims
$29 - $52 per hour
...Optum Clinical Claim Review Nurse Optum is a global organization that delivers care, aided... ...performs claim reviews to verify correct coding and correct charges. The clinical reviewer... ...including clinical claim review, medical record review, and a broad knowledge of...Remote jobClaimsHourly payMinimum wageFull timeContract workTemporary workWork experience placementWork at officeLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Clinical Investigator: Medical Coding & Claims. Be the first to apply!
Related searches
- corporate security investigator Minneapolis, MN
- security investigator Minneapolis, MN
- housing investigator Minneapolis, MN
- insurance investigator Minneapolis, MN
- forensic investigator Minneapolis, MN
- investigator Minneapolis, MN
- healthcare investigator Minneapolis, MN
- case investigator Minneapolis, MN
- aml investigator Minneapolis, MN
- compliance investigator Minneapolis, MN