SIU Analyst

Description

Healthcare Fraud Shield, a leader in healthcare fraud prevention and payment integrity solutions, is looking for a talented SIU Analyst to join our team.

Key Responsibilities

• Assist and support the SIU team (Managers, Clinical Reviewers, CPCs, Investigators, and Analysts) with daily tasks.
• Help with the intake and triage of client-assigned tasks.
• Assist in the analysis of patient medical records for FWA investigations.
• Support the comparison of medical records to claim information to determine billable services.
• Help with documenting findings for each claim line in a spreadsheet.
• Contribute to summarizing findings in a written report.
• Assist with abstracting CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records.
• Support the team in maintaining current knowledge of coding guidelines and regulations.
• Assist with data analysis of client data.
• Provide basic support for various aspects of FWA investigations.
• Comply with all company Privacy and Security standards.
• Understand and follow all company Privacy and Security standards.
• Respect and protect confidential and sensitive information, including protected health information.
• Perform other duties as assigned.

Skills, Knowledge and Expertise

• Basic knowledge of medical terminology.
• Basic knowledge of coding concepts, including CPT, HCPCS, and ICD-10.
• Basic knowledge of specialty medical practices.
• Attention to detail.
• Ability to communicate clearly and effectively, both verbally and in writing.
• Good listening skills.
• Ability to work both independently and as part of a team.
• Responsible and self-disciplined.
• Ability to meet defined performance and production goals.
• Basic computer skills.
• This job requires access to confidential and sensitive information, which means discretion and secure information management are essential.

Certificate/License:

• No specific investigative experience is required, but healthcare knowledge and a strong interest in medical claims, coding, and investigations is a plus.

Benefits

• Medical, Dental & Vision insurance
• 401(k) retirement savings with employer match
• Vacation and sick paid time off
• 7 paid holidays & 2 floating holidays
• Paid maternity/paternity leave
• Disability & Life insurance
• Flexible Spending Account (FSA)
• Employee Assistance Program (EAP)
• Professional and career development initiatives
• Remote work eligible

REMOTE WORK REQUIREMENTS:

• Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.

Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

About Healthcare Fraud Shield

Healthcare Fraud Shield, headquartered in Chesterfield, MO, is a leading provider of innovative fraud, waste, and abuse (FWA) solutions for healthcare insurance payers. Since its establishment in 2011, the company has focused solely on healthcare fraud prevention and payment integrity, delivering unique advantages to its broad client base. At the heart of Healthcare Fraud Shield's offerings is FWAShield™, an integrated platform designed by industry-leading healthcare experts. This comprehensive solution includes PreShield™ (pre-payment), PostShield™ (post-payment), RxShield™ (pharmacy analytics), CaseShield™ (case management), and QueryShield™ (ad-hoc querying tool). Leveraging the latest technology available, Healthcare Fraud Shield provides the most affordable, flexible, transparent, efficient, and effective solution in the marketplace. With over 20 years of experience, the founders of Healthcare Fraud Shield are pioneers in successful fraud detection software development in the financial services industry. They have designed their suite of software to identify superior FWA rates, utilizing advanced analytics, AI, and the best exterior data. Additionally, Healthcare Fraud Shield offers expert services in detecting and verifying suspected FWA billed services, including the development of claim edit rules. Their experienced SIU team, which includes Accredited Health Care Fraud Investigators and Certified Professional Coders, delivers top-notch training throughout the country. Trust Healthcare Fraud Shield to safeguard your healthcare insurance payments and ensure payment integrity.