CPC Certified Clinical Investigator

Job Summary

Seeking a CPC Certified Clinical Investigator, the full-time remote position will audit medical records to identify inappropriate billing practices, conduct retrospective and prepayment reviews, and recommend preventative measures to enhance compliance and reduce fraud.

Key responsibilities:

• Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud
• Investigate and analyze provider billing patterns to recommend appropriate payments based on medical records and regulatory guidelines
• Prepare summaries of findings and recommend changes to internal policies and procedures to prevent future fraudulent practices

Required qualifications:

• CPC or CPMA certification required
• Associate's Degree in a related field or equivalent experience preferred
• Minimum of 2 years of related clinical experience required
• Licensing in nursing, counseling, or therapy (e.g., RN, LPC, LPN, LCSW) or related fields required
• Provider education experience preferred