Certified Professional Coder Analyst

Job Summary

A company is looking for a SIU Senior Recovery Resolution Analyst.

Key Responsibilities:

• Triaging, investigating, and resolving potential instances of healthcare fraud and/or abusive conduct
• Gathering and analyzing data to determine behavior and understand provider/scheme issues
• Collaborating with external sources and conducting interviews to identify patterns related to fraud, waste, and abuse

Required Qualifications:

• High School Diploma/GED and 5+ years of experience in FWA/SIU or Fraud investigations, or an Associate's degree in Criminal Justice
• Certified Professional Coder (CPC)
• 2+ years of experience in the health insurance claims industry
• 1+ years of knowledge and/or experience with medical/behavioral health codes
• Intermediate proficiency in Microsoft Excel and Word