Prepay Coding Investigation Consultant (Remote)

!Prepay Coding Investigation Consultant

Remote Opportunity

We are seeking an experienced Prepay Coding Investigation Consultant to investigate and resolve potential healthcare fraud, waste, and abuse (FWA) involving medical providers. This role uses medical records, member benefits, tips, and investigative leads to identify and document findings while supporting coding accuracy and regulatory compliance.

Key Responsibilities

• Investigate potential healthcare fraud, waste, and abuse involving medical providers.
• Review medical records, member benefits, tips, and investigative leads.
• Analyze and document findings to support investigation conclusions.
• Apply CPT and ICD coding knowledge to complex medical coding issues.
• Provide coding guidance to investigators, particularly related to CPT codes.
• Mentor and provide explanations and feedback on complex coding and investigative issues.
• Collaborate with internal and external stakeholders to fulfill client requests.
• Support internal and external projects and assigned performance goals.
• Maintain compliance with applicable healthcare regulations, policies, and procedures.
• Meet established productivity, quality, and performance metrics.

Required Qualifications

Candidates must meet one of the following:

• Licensed RN or LPN with coding credentials/certification, OR
• Certified Coder with 3+ years of coding experience in surgical, hospital, and/or clinic settings.

Required Skills

• CPT coding experience – Required
• ICD coding experience – Required
• Strong medical coding knowledge
• Strong critical-thinking and analytical skills
• Excellent problem-solving and investigative skills
• Strong attention to detail
• Proficiency with PC-based software and Microsoft Office
• Ability to review and interpret medical records
• Ability to communicate complex coding issues clearly
• Ability to work independently while collaborating with internal and external teams

Ideal Background

Candidates with experience in medical coding, auditing, healthcare investigations, surgical coding, hospital coding, clinic coding, claims review, or fraud/waste/abuse investigations are encouraged to apply.

How to Apply

Please send your resume to [email protected].

Subject Line: Prepay Coding Investigation Consultant

Please ensure your resume clearly lists your coding certification, CPT/ICD experience, and healthcare coding experience.

Know someone who may be a great fit? Please share this opportunity with your professional network!

Pay: $41.00 per hour

Expected hours: 40.0 per week

Work Location: Remote