Top 26 siu coding investigator Jobs

Senior Investigator - Hybrid/Remote Possible
EmblemHealth —New York, NY
- $68,040 - $118,800 a year
- Remote
- Microsoft Outlook
- Public speaking
- Mid-level
SIU & Payment Integrity AI Analyst
Codoxo —Duluth, GA
- Temporary
- Remote
- 5 years
- Senior level
- Leadership
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SIU Healthcare Investigator (Full-time, Remote)
Integrity Management Services, Inc. —Alexandria, VA
- Full-time
- Remote
- Microsoft Excel
- Writing skills
- Mid-level
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3d
Senior Investigator, Special Investigations Unit (Aetna SIU)
CVS Health —Washington, DC
- $46,988 - $122,400 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
FWA Special Investigations Unit (SIU) Investigator
Summa Health —Akron, OH
- $28.10 - $42.15 an hour
- Full-time
- Remote
- Microsoft Office
- Analysis skills
- Bachelor's degree
- AD&D insurance
- Disability insurance
2d
Certified Coder, Special Investigations Unit (SIU)
Summa Health —Akron, OH
- $28.10 - $42.15 an hour
- Full-time
- Remote
- Research
- Mid-level
- Microsoft Office
- AD&D insurance
- Disability insurance
2d
Investigator II
Point32Health —Canton, MA
- $80,741.22 - $121,111.82 a year
- Full-time
- Computer Science
- Research
- Office
- Disability insurance
- Health insurance
3d
Senior Fraud Investigator-NYC (Hybrid)
1199SEIU Family of Funds —New York, NY
- $89,200 - $111,500 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Office
Senior Specialist, Coding Auditor
Oscar Health —New York, NY
- $58,870 - $85,853 a year
- Remote
- HIPAA
- Mid-level
- Bachelor's degree
- Paid parental leave
- Paid holidays
Quick Apply
5d
RN Clinical Auditor
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- Nursing
- RN License
- Mid-level
- Health insurance
Quick Apply
Senior Nurse Investigator (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $68,832 - $136,708 a year
- Online Application
- Nursing
- RN License
- HIPAA
Quick Apply
Manager, SIU Prepay Investigations
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- Management
- Mid-level
- Supervising experience
- Paid holidays
- Health insurance
22h
Special Investigations Unit Clinical Certified Coder
MetroPlus Health Plan —New York, NY
- $100,000 - $110,000 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- 5 years
7d
SIU Nurse Auditor, RN, CPC (Full-time, Remote)
Integrity Management Services, Inc. —Alexandria, VA
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
Quick Apply
10h
Special Investigations Unit Senior Investigator
CVS Health —Lansing, MI
- $46,988 - $102,000 a year
- Full-time
- Customer service
- 5 years
- Research
- Health insurance
- Dental insurance
7d
Analyst, Special Investigative Unit (Must Reside in Louisiana)
CVS Health —Baton Rouge, LA
- $43,888 - $76,500 a year
- Full-time
- Customer service
- Mid-level
- 3 years
- Health insurance
- Dental insurance
7d
Senior Management Consultant
NYC Health + Hospitals —New York, NY
- $100,000 - $110,000 a year
- Full-time
- Nursing
- RN License
- 5 years
4h

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Senior Investigator - Hybrid/Remote Possible

EmblemHealth -
New York, NY

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Job Details

$68,040 - $118,800 a year

Qualifications

Microsoft Outlook
Presentations for conferences or internal meetings
ICD-9
Microsoft Teams
SharePoint
Medical terminology

Full Job Description

Summary of Job

Conduct complex, in-depth investigations of reported fraud involving the full range of healthcare products. Develop and maintain relationships with law enforcement (HHS-OIG, FBI, DOJ), regulatory agencies (DFS, MEDIC, OMIG, MFCU) and with industry peers. Provide guidance to the Fraud Investigators on SIU investigations and issues. Assist with anti-fraud training sessions and public speaking engagements.

Responsbilities

Investigate complex cases of reported fraud involving the Company’s Medicaid healthcare product.
Develop leads from various sources to review for suspect activity.
Review claim files and develop action plans for the investigation.
Conduct highly comprehensive interviews/interrogations with providers.
Conduct medical records assessments, and CPT coding issues.
Provide guidance and mentor to the Fraud Investigators.
Answer and respond to SIU Fraud Hotline cases when assigned based on schedule.
Triage complaints that come to the SIU and follow through on resolution.
Participate in meetings with providers, attorneys, law enforcement on a case-by-case basis as needed.
Attend training, conferences, webinars to keep up to date on current trends and schemes of Fraud, Waste & Abuse.
May assist with fraud awareness training sessions and public speaking engagements.
Establish and maintain relationships with law enforcement (HHS-OIG, FBI), regulatory agencies (i.e DFS, MEDIC, OMIG, MFCU, NYS OAG), and with industry peers.
Refer cases to law enforcement or regulatory agencies as needed.
Periodically meet with representatives from law enforcement and regulatory agencies to keep updated on current trends.
Handle and respond to Requests for Information (RFI) from law enforcement and regulatory agencies.
Perform other duties as directed, assigned, or required.

Qualifications

Bachelor’s degree in criminal justice or related field.
AHFI and/or CFE certification (Preferred)
4 – 6+ years of relevant, professional work experience
Additional experience/specialized training may be considered in lieu of a bachelor’s degree (Required)
Professional investigation experience in economic or insurance related matters (Required)
Experience in insurance claims investigation or law enforcement (Preferred)
Strong knowledge of CPT and ICD9-CM coding, medical terminology, and treatment options (Required)
Proficiency in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
Attention to detail, critical thinking and problem-solving skills (Required)
Ability to monitor and review information from materials, events, or the environment, to detect or assess problems (Required)

Additional Information

Requisition ID: 1000002978_01
Hiring Range: $68,040-$118,800

Apply Now

Refine Your Search

siu coding investigator jobs

Senior Investigator - Hybrid/Remote Possible

SIU & Payment Integrity AI Analyst

SIU Healthcare Investigator (Full-time, Remote)

Senior Investigator, Special Investigations Unit (Aetna SIU)

FWA Special Investigations Unit (SIU) Investigator

Certified Coder, Special Investigations Unit (SIU)

Investigator II

Senior Fraud Investigator-NYC (Hybrid)

Senior Specialist, Coding Auditor

RN Clinical Auditor

Senior Nurse Investigator (Hybrid)

Manager, SIU Prepay Investigations

Special Investigations Unit Clinical Certified Coder

SIU Nurse Auditor, RN, CPC (Full-time, Remote)

Special Investigations Unit Senior Investigator

Analyst, Special Investigative Unit (Must Reside in Louisiana)

Senior Management Consultant

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