Certified Coding Investigator

To support the Special Investigative Unit, the full-time Certified Coding Investigator will investigate and resolve instances of healthcare fraud, waste, and abuse by reviewing medical claims and records while working remotely. Key responsibilities Independently re-evaluates medical claims and associated records for accuracy based on coding standards and regulations Manages documentation and prioritizes caseloads to ensure timely resolution of investigations Communicates findings and participates in meetings related to cases, facilitating referrals to law enforcement when necessary Required qualifications At least 2 years of CPT coding experience in a surgical, hospital, and/or clinic setting Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar credential Knowledge of managed care, Medicaid, Medicare, and Marketplace programs Understanding of claim billing codes, medical terminology, and healthcare delivery systems Ability to research and interpret regulatory requirements effectively