State Licensed Clinical Investigator
Job Summary
To support the Special Investigation Unit, the full-time State Licensed Clinical Investigator will audit medical records to identify inappropriate billing practices and recommend corrective actions while working remotely.
Key responsibilities
- Perform retrospective and prepayment reviews of medical records to detect potential abuse and fraud
- Investigate and analyze provider billing patterns to recommend appropriate payment based on regulations and guidelines
- Prepare summaries of findings and suggest preventative measures to enhance internal policies and procedures
Required qualifications
- Associate's Degree in a related field or equivalent experience preferred
- 2+ years of related clinical experience in the field of obtained license required
- Coding certification from an accredited organization or relevant clinical license (e.g., RN, LPC, LPN)
- Experience with CPT coding preferred
- Provider education experience preferred
Complete Job Description
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