Certified Coding Investigator

Job Summary

A company is looking for an Investigator, Special Investigative Unit Coding (Remote).

Key Responsibilities

• Re-evaluates medical claims and records to identify coding fraud, waste, and abuse
• Reviews post-pay claims for accuracy against medical records and manages caseloads efficiently
• Communicates findings and participates in meetings related to investigations

Required Qualifications

• At least 2 years of CPT coding experience in a surgical, hospital, or clinic setting
• Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar
• Knowledge of investigative procedures and health care delivery systems
• Understanding of claim billing codes and regulatory requirements
• Experience in fraud, waste, and abuse investigations may be required in some states