State Licensed Clinical Investigator

Job Summary

A company is looking for a Clinical Investigator I (Special Investigation Unit).

Key Responsibilities

• Audit medical records to identify inappropriate billing practices and recommend next steps
• Investigate and analyze provider billing patterns to recommend payments based on various guidelines
• Prepare findings summaries and recommend changes to prevent future fraudulent practices

Required Qualifications, Training, and Education

• Associate's Degree in a related field or equivalent experience preferred
• 2+ years of related clinical experience in the field of obtained license required
• Provider education preferred
• Coding certification from an accredited organization required
• Relevant clinical licenses (e.g., RN, LPC, LPN, LCSW, LMHC, PT, OT, ST) required