Remote SIU Investigator: Healthcare Coding & Fraud
Healthcare Fraud Shield
A leading company in healthcare fraud prevention is seeking a talented Coder or Clinical Coder/Fraud Investigator. This full-time role involves analyzing patient medical records, documenting findings, and ensuring compliance with coding guidelines. The position is remote work eligible, requiring a CPC certification and a minimum of one year of coding experience. Join a dedicated team committed to preventing healthcare fraud and ensuring payment integrity. #J-18808-Ljbffr
- ...your job application. Healthcare Fraud Shield will not contact... ...Clinical Coder/Fraud Investigator to join our team. RESPONSIBILITIES... ...Work with SIU Team (Clinical Reviewers... ...to make appropriate coding determinations as needed... ...initiatives Remote work eligible REMOTE WORK...Remote workFraudFull timeFlexible hours
$79.56k - $115.72k
## SIU Fraud InvestigatorApply: Hybrid: Somerville-MA: Full time:... ...exciting place to be within the healthcare industry. As a member of... ...for conducting confidential investigations of suspected fraud, waste &... ...8:30-5:00 PM Eastern Time* Remote workspace requirements, including...Remote workFraudFull timeContract workWork at officeLocal areaMonday to FridayFlexible hoursShift work- ...Conducting detailed investigations into potential fraud, waste, and abuse in healthcare claims, the full-time remote Special Investigator will review medical records and claims data... ...fraud patterns Knowledge of healthcare coding, billing, and documentation standards...Remote workFraudFull time
$56.2k - $101k
...flexibility. Please note: this is a remote role with preference on... ...residing within Ohio.Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning... ...analyze health care claims and coding required. Pay Range: $56,200.00 -...Remote workFraudFull timePart timeWork at officeFlexible hours- UnitedHealth Group is seeking a Coding Consultant to investigate and resolve healthcare fraud and provider abuse using CPT coding guidance. You will mentor investigators, review claims against medical records, and coordinate with internal and external stakeholders to ensure...Remote jobFraud
$79.56k - $115.72k
...an exciting place to be within the healthcare industry. As a member of Mass General... ...Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving... ...generally 8:30-5:00 PM Eastern Time Remote workspace requirements, including...Remote workFraudFull timeContract workWork at officeLocal areaMonday to FridayFlexible hoursShift work- ...Clinical Certified Coder to support fraud detection and investigations in the Special Investigations Unit.... ...years of relevant experience and AAPC coding certification are required. This... ...and integrity in handling sensitive healthcare information. #J-18808-Ljbffr MetroPlusHealthFraud
- ...Centene Corp. seeks an SIU Investigator to conduct fraud, waste and abuse investigations across referrals, claims data and medical records. You will... ...in the U.S. without visa sponsorship now or in the future. Remote options are available within the U.S. #J-18808-Ljbffr...Remote workFraudVisa sponsorship
$25 - $29 per hour
...the past 28 years, Advantage Investigations has been the Nation's only insurance... ..., Net-Sweep Investigations, Remote Controlled Surveillance, and... ...time and money on insurance fraud cases. Advantage... ...Investigations is seeking a Part-Time SIU/Claims Investigator in NYC,...Remote workFraudBi-weekly payHourly payPart timeWork at officeFlexible hours$61.9k - $102.9k
...SIU Investigator Location(s): Dallas, Texas Kemper is one of the nation's leading specialized... ...Special Investigator will function as a remote investigator working from her/his... ...SIU contacts, the Department of Insurance Fraud Division, NICB, and various law enforcement...Remote workFraudWork experience placementWork at office- ...happen. Job Summary A Special Investigations Unit (SIU) Desk Investigator within an insurance... ...investigations involving suspicions of insurance fraud related to the application of... ...standards, and professional codes of conduct to maintain trust and credibility...Remote workFraudContract workWork at officeRelocation package
$46.99k - $112.2k
...Senior Investigator, Aetna Special Investigations Unit We're building... ...known or suspected acts of healthcare fraud and abuse. This position... ...proactive data mining using SIU Tools to identify aberrant billing... ...knowledge of medical coding; CPT, HCPCS, ICD10 ~ Proficient...Remote workFraudHourly payFull timeTemporary workWork at officeLocal area$25 - $50 per hour
...strategy & scheduling Paid travel for field investigations when required Job Summary The SIU Investigator conducts field and remote investigations involving insurance claims. This... ...principles, compensability analysis, fraud indicators, and investigative documentation....Remote workFraudHourly payPart timeWork at officeHome officeFlexible hoursAfternoon shift- Optum is seeking a seasoned investigator to support SIU/FWA efforts in Virginia. You will analyze data and evidence, interview members and providers... ..., and stakeholders. This role requires 5+ years in FWA or fraud investigations, experience with health insurance claims,...Remote jobFraud
$65k - $88.6k
...Healthcare Investigator Humana is looking for an experienced Healthcare... ...passion for combating Fraud, Waste, and Abuse in... ...to join Humana's SIU. The Fraud and Waste... ...record reviews CPT code experience Experience... ...: While this is a remote position, occasional travel...Remote workFraudTemporary workWork at officeLocal areaWork from homeHome office$80.99k - $121.49k
...high-quality, affordable healthcare. Serving nearly 2... ...Health. Job Summary The Investigator II is an essential team... ...Investigation Unit (SIU) responsible for leading... ...related to fraud, waste, and abuse, and... ...contract provisions, coding rules, coverage rules,...FraudContract workWork at officeWork from homeFlexible hours$80.2k - $118.3k
...customers’ lives by making healthcare work better, is far from ordinary... ...of Premera’s Special Investigations Unit (SIU), the Investigator III leads... ...allegations of external fraud, waste, and abuse (FWA). This... ...Healthcare Common Procedure Coding System (HCPCS). Strong...FraudWork experience placementWork at office$56.2k - $101k
## SIU InvestigatorApply: Remote-NY: Remote-MA: Remote-CT: Remote-PA: Remote... ...Purpose:** Conduct fraud, waste, and abuse (FWA) investigations by reviewing referrals... ...may present risks to healthcare programs and recommend... ...records, billing and coding documentation, provider...Remote workFraudFull timePart timeH1bWork at officeFlexible hours- ...Description The Nurse Investigator works as part of the... ...Investigations Unit (SIU) team, detecting and investigating... ...suspected fraud, waste, and abuse (FWA... ...of clinical reviews, coding and documentation, conducting... ..., and resolve healthcare fraud, waste, and abuse...FraudContract workWork at office
- A leading health organization seeks an investigator for healthcare fraud allegations. Responsibilities include conducting investigations, analyzing... ...a minimum of 5 years in fraud investigations. This is a remote role with a strong preference for residents of New York....Remote workFraud
- ...Manager for the Special Investigative Unit/Program Integrity (CPC) role, supporting remote work across several... ...will lead a multi-state SIU team and coordinate with... ...certification, and 5 years of coding experience with 2 years... ...strong alignment to fraud, waste and abuse...Remote jobFraud
- ...Centene Corporation seeks an Investigator to conduct fraud, waste, and abuse investigations across healthcare programs. You will review referrals, claims data, and medical records, document findings, and support case resolution while ensuring regulatory and contractual...Remote workFraud
- ...established organization looking for Insurance Fraud Investigator (SIU) to join our team. Family-owned, UAIC,... ...state where we conduct business. Remote position, and must be located in the... ..., a strong plus. Experience in CPT codes and medical terminology is highly...Remote workFraudFull timeTemporary workWork experience placementWork at officeFlexible hours
- ...corporate office with remote work flexibilityTravel... ...to 25%The Compliance Investigator is responsible for conducting... ...safety, privacy, and healthcare operations across one... ...complianceBilling and coding concernsFraud, waste,... ...(CHPC)Certified Fraud Examiner (CFE)Comparable...Remote workFraudWork at office
- ...Leading complex fraud investigations in healthcare billing, coding, and claims, the full-time remote Senior Fraud Investigator will analyze large data sets to identify patterns of fraud, prepare detailed reports, and collaborate with clients and internal teams while mentoring...Remote workFraudFull time
- ...Healthcare Fwa Investigator Levels (Investigator, Sr. Investigator, etc) will... ...and prevention of healthcare fraud, waste and abuse (FWA). We... ..., CPT, HCPCS, DRG, and rev codes Ability to demonstrate professionalism... ...independently within a remote team, under minimal...Remote workFraud
- ...Job Opportunity Council Capital is a healthcare-focused private equity firm based in... ...analytics with expert review to surface fraud, waste, and abuse across Medicare, Medicaid... ...but you will not manage anyone. Strong investigators here come from healthcare payer/vendor...Remote workFraud
- ...Compliance Investigator At Fresenius Medical Care, we... ...care across the entire healthcare journey. Guided by our... ...data in the context of fraud, embezzlement,... ...Complies with the Code of Business Conduct and... ...essential functions. Remote with travel as needed...Remote workFraudWork experience placementLocal areaWorldwideFlexible hours
- Centene Corporation seeks an investigator to conduct fraud, waste, and abuse investigations across healthcare data, records, and referrals. You will prepare case reports,... ...agencies is common, and a flexible schedule with potential remote #J-18808-Ljbffr Centene CorporationRemote jobFraudFlexible hours
$60.2k - $107.4k
...flexibility to work remotely* as you take on... ...Collaborate with clinical coding consultant to... ...of aberrances (SIU only) Gather all relevant... ...through an Investigation Summary and compliance... ...in a FWA / SIU or Fraud investigations 2+... ...(CFE), Accredited Healthcare Fraud Investigator...Remote workFraudMinimum wageFull timeWork experience placementLocal area
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