SIU 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 10/23/2026full-timeRemote • Missouri • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical coding and billing, including proficiency in CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10. Capable of analyzing medical records for fraud, waste, and abuse investigations while maintaining compliance with privacy standards.

Highest-signal resume keywords

Certified Professional Coder (CPC)Medical Coding KnowledgeData Analysis SkillsAttention to DetailEffective Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingHCPCS CodingRevenue CodesDRG CodesICD-9 CodingICD-10 CodingMedical TerminologyData MiningQuality ChecksBilling Analysis

Soft Skills

Detail OrientedStrong Listening SkillsIndependentResponsibleSelf-Disciplined

Tools & Technologies

Spreadsheet SoftwareHigh-Speed Internet

Certifications & Qualifications

Certified Professional Coder (CPC)

Industry Keywords

Fraud Waste Abuse (FWA)Coding GuidelinesPatient Medical RecordsConfidential Information ManagementFederal RegulationsState Regulations

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, including behavioral-related records and other specialties, for FWA investigations
Compare medical records with submitted claims to determine the amount and nature of billable services
Determine the 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 and lead generation/data mining of client data
Conduct various aspects of FWA investigations
Provide subject matter expertise and SIU support to clients
Comply with company privacy and security standards
Protect and appropriately handle protected health information
Perform other duties as needed

Requirements

What you’ll need

Knowledge of medical terminology
Knowledge of coding including CPT, HCPCS, Revenue Codes, DRG Codes, and ICD-10
Knowledge of specialty medical practices
Must be detail oriented
Ability to communicate effectively both verbally and in writing
Strong listening skills
Independent
Responsible
Self-disciplined
Ability to meet defined performance and production goals
Strong computer skills
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management
Certified Professional Coder (CPC®) through governing body AAPC or equivalent certification
Minimum of one year of coding and/or billing experience is required.
Must have high-speed internet with minimum 25 Mbps download and 5 Mbps 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
Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.