SIU Clinical Investigator

Healthcare Fraud Shield

. Work with the SIU team, including Clinical Reviewers, CPCs, Investigators, and Analysts; perform quality checks, assist with research, and discuss coding determinations .

Posted 10/26/2026full-timeRemote • Missouri • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding and billing, with a strong focus on CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10. Capable of conducting thorough fraud, waste, and abuse investigations while maintaining compliance with privacy standards.

Highest-signal resume keywords

Certified Professional Coder (CPC®)Medical Coding ExperienceKnowledge of CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10Data Analysis SkillsEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingBilling AnalysisData AnalysisCPT CodingHCPCS CodingRevenue CodingDRG CodingICD-10 CodingFraud InvestigationQuality Checks

Soft Skills

Detail-OrientedEffective Verbal CommunicationStrong Listening SkillsIndependentSelf-Disciplined

Tools & Technologies

Spreadsheet SoftwareHigh-Speed Internet

Certifications & Qualifications

Certified Professional Coder (CPC®)

Industry Keywords

Medical TerminologyCoding GuidelinesFraud, Waste, and Abuse InvestigationsPrivacy StandardsProtected Health Information

About the role

Key responsibilities & impact

Work with the SIU team, including Clinical Reviewers, CPCs, Investigators, and Analysts; perform quality checks, assist with research, and discuss coding determinations
Analyze and interpret patient medical records for fraud, waste, and abuse investigations
Compare claims information to determine the amount and nature of billable services
Determine appropriateness of billing and reimbursement
Document findings for each claim line in a spreadsheet
Summarize findings in written reports
Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-9/ICD-10 from medical records
Maintain current knowledge of coding guidelines and relevant federal and/or state regulations
Perform data analysis of client data
Conduct various aspects of fraud, waste, and abuse investigations
Provide subject matter expertise and SIU support to clients
Comply with privacy and security standards
Protect and properly handle protected health information
Perform other duties as needed

Requirements

What you’ll need

Certified Professional Coder (CPC®) through governing body AAPC
Minimum of one year of coding and/or billing experience
Knowledge of medical terminology
Knowledge of CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10 coding
Knowledge of specialty medical practices
Detail-oriented
Effective verbal and written communication
Strong listening skills
Independent, responsible, and self-disciplined
Ability to meet defined performance and production goals
Strong computer skills
Ongoing discretion and secure information management for confidential and sensitive information
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 minimum 25mbs download and 5mbs upload; satellite Internet is not allowed