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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in medical terminology and coding concepts, including CPT, HCPCS, and ICD-10, while maintaining confidentiality and compliance with privacy standards. Capable of analyzing medical records for fraud, waste, and abuse, and effectively documenting findings.
Highest-signal resume keywords
Medical Terminology KnowledgeCPT CodingICD-10 CodingAttention to DetailData Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CPT CodingHCPCS CodingICD-10 CodingData AnalysisMedical Record AnalysisDocumentationCoding Guidelines KnowledgeClaim ComparisonAbstracting Revenue CodesAbstracting DRG Codes
Soft Skills
Effective CommunicationGood Listening SkillsTeam CollaborationSelf-DisciplineAttention to Detail
Tools & Technologies
Spreadsheet SoftwareHigh-Speed Internet
Industry Keywords
Fraud InvestigationWaste ManagementAbuse InvestigationHealthcare KnowledgePrivacy StandardsSensitive Information Management
About the role
Key responsibilities & impact- Assist and support the SIU team with daily tasks
- Help with intake and triage of client-assigned tasks
- Assist in analyzing patient medical records for fraud, waste, and abuse investigations
- Support comparison of medical records with claim information to determine billable services
- Document findings for each claim line in a spreadsheet
- Contribute to written reports summarizing findings
- Assist with abstracting CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records
- Support maintaining current knowledge of coding guidelines and regulations
- Assist with client data analysis
- Provide basic support for various aspects of fraud, waste, and abuse investigations
- Comply with and follow company Privacy and Security standards
- Respect and protect confidential and sensitive information, including protected health information
- Perform other duties as assigned
Requirements
What you’ll need- Basic knowledge of medical terminology
- Basic knowledge of coding concepts, including CPT, HCPCS, and ICD-10
- Basic knowledge of specialty medical practices
- Attention to detail
- Ability to communicate clearly and effectively, both verbally and in writing
- Good listening skills
- Ability to work both independently and as part of a team
- Responsible and self-disciplined
- Ability to meet defined performance and production goals
- Basic computer skills
- Discretion and secure information management when accessing confidential and sensitive information, including protected health information
- No specific investigative experience is required; healthcare knowledge and a strong interest in medical claims, coding, and investigations is a plus
- High-speed internet with minimum 25mbs download and 5mbs upload; satellite internet is not allowed
Benefits
Comp & perks- Medical, Dental & Vision insurance
- 401(k) retirement savings with employer match
- Vacation and sick paid time off
- 7 paid holidays & 2 floating holidays
- Paid maternity/paternity leave
- Disability & Life insurance
- Flexible Spending Account (FSA)
- Employee Assistance Program (EAP)
- Professional and career development initiatives
- Remote work eligible
- High speed Internet required with a minimum speed of 25mbs download and 5mbs upload; satellite is not allowed