Minnesota Licensed Clinical Investigator

Job Summary

To ensure compliance and accuracy in medical billing, the Minnesota Licensed Clinical Investigator will perform quality audits of clinical review cases, analyze claims against medical records, and provide coding expertise while working remotely in a full-time capacity.

Key responsibilities:

• Conducts quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment
• Determines the accuracy of medical coding and provides payment recommendations for pre-payment claims
• Identifies billing patterns and trends, ensuring adherence to compliance policies and managing daily case review assignments

Required qualifications:

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