Investigator

Job Summary

A company is looking for an Investigator to conduct audits and reviews of cases related to coding and billing compliance.

Key Responsibilities

• Conduct detailed audits and reviews of cases to assess compliance with coding, documentation, and billing standards
• Identify potential instances of fraud, waste, and abuse, and verify charges
• Generate preliminary and final audit results and collaborate with clients for report delivery and overpayment recovery

Required Qualifications

• Strong auditing, medical record review, and documentation skills
• Knowledge of coding standards, billing practices, and compliance requirements
• Experience with data analytics and fraud detection techniques
• Bachelor's degree in a related field and relevant certifications are a plus
• Familiarity with HIPAA regulations and corporate integrity agreements