Minnesota Licensed Clinical Investigator

Job Summary

To support accurate claims processing, the part-time Minnesota Licensed Clinical Investigator will analyze medical records and claims submissions, ensuring compliance with coding requirements and state regulations while working remotely in a production-driven environment.

Key responsibilities:

• Conduct quality audits of clinical review cases and determine accuracy of medical coding and billing for pre-payment claims
• Analyze data and medical records to identify billing patterns, trends, and potential fraud or abuse
• Manage daily case review assignments, ensuring adherence to compliance turnaround times and productivity standards

Required qualifications:

• High School Diploma or GED
• Certified Coder (AHIMA or AAPC) or active Nurse (RN, LPN) license with medical record auditing experience
• 2+ years of experience in medical coding (CPT/HCPCS/ICD-10) or as a licensed nurse with coding experience
• 1+ year of experience in a metrics-driven team environment
• Intermediate to advanced knowledge of health insurance terminology and regulatory guidelines