The SIU Investigator performs reviews of claim lines flagged by Community's SIU and Community's SIU Contractor. The SIU investigator will assist the SIU manager in gathering information from internal and external partners for investigations and audits. The SIU investigator will coordinate with internal and external resources in determining the appropriateness of codes found in administrative and medical claims and develop reports of findings and recommendations for the SIU function.
Bachelor's degree required, Certification in Coding and Medical Billing, Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Investigator (CFE) certification required
5 years' experience in Healthcare coding in the medical industry directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing.
Solid Knowledge of Medicare, Medicaid and commercial coding practices.
Thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS) and International Classification of Diseases, and Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version)
Above Average Verbal (Heavy Public Contact);
Writing /Composing (Correspondence / Reports)
Internal Number: 153677
About Harris Health System
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.