Coder-Senior Investigator
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
Are you a skilled and detail-oriented coder with a passion for investigating complex healthcare cases? Presbyterian Healthcare Services is seeking a Senior Investigator to join our team and utilize your expertise to uncover any potential coding errors or fraudulent activities. This role offers the opportunity to make a significant impact on the healthcare industry while working alongside a dedicated team. If you have a strong background in coding and a keen eye for detail, we would love to hear from you. Join us and help us continue to provide high-quality care to our community.
Conduct thorough investigations of complex healthcare cases to identify potential coding errors or fraudulent activities.
Utilize coding expertise and knowledge of industry regulations to accurately assess and determine the validity of healthcare claims.
Collaborate with cross-functional teams, including healthcare providers and legal professionals, to gather and analyze evidence.
Prepare detailed reports and presentations to communicate findings and recommendations to management.
Stay updated on industry trends, regulations, and coding practices to ensure the accuracy and effectiveness of investigations.
Develop and implement strategies to proactively identify and prevent potential coding errors or fraudulent activities.
Train and mentor junior investigators on coding practices and investigative techniques.
Maintain strict confidentiality and adhere to ethical standards while handling sensitive information.
Act as a liaison with external agencies, such as law enforcement and regulatory bodies, when necessary.
Participate in regular team meetings and provide input to improve processes and procedures.
Presbyterian Healthcare Services is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job
Conduct thorough investigations of complex healthcare cases to identify potential coding errors or fraudulent activities.
Utilize coding expertise and knowledge of industry regulations to accurately assess and determine the validity of healthcare claims.
Collaborate with cross-functional teams, including healthcare providers and legal professionals, to gather and analyze evidence.
Prepare detailed reports and presentations to communicate findings and recommendations to management.
Stay updated on industry trends, regulations, and coding practices to ensure the accuracy and effectiveness of investigations.
Develop and implement strategies to proactively identify and prevent potential coding errors or fraudulent activities.
Train and mentor junior investigators on coding practices and investigative techniques.
Maintain strict confidentiality and adhere to ethical standards while handling sensitive information.
Act as a liaison with external agencies, such as law enforcement and regulatory bodies, when necessary.
Participate in regular team meetings and provide input to improve processes and procedures.
Presbyterian Healthcare Services is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job