Clinical Investigator I (Special Investigation Unit)

From the original posting

Position Purpose: Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Key Details: Preferred qualifications include coding certification, nurse coding experience, and experience with CPT coding. Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices Investigate, analyze, and identify provider billing patterns to recommend payment based on medical…