Clinical Investigator II - Remote

Overview

The Clinical Investigator II role involves auditing medical records to identify billing practices and ensuring compliance with medical necessity through detailed reviews.

In Short

• Audit medical records for inappropriate billing practices.
• Perform complex reviews of medical records for fraud detection.
• Conduct second-level appeals reviews.
• Investigate provider billing patterns.
• Prepare findings and recommend next steps.
• Consult with investigators on abuse and fraud detection.
• Conduct onsite audits with investigators.
• Provide instructions for prepayment reviews.
• Assist in training new hires and junior employees.
• Comply with all company policies and standards.

Requirements

• Associate’s degree in Nursing, Counseling, or related field preferred.
• Coding Certification and 4+ years of medical coding experience.
• Licensure as RN, LPC, LCSW, LMHC, PT, OT, or ST.
• Experience in provider education preferred.
• Experience in a managed care organization preferred.
• Experience in medical record auditing preferred.
• Coding certification from an accredited organization.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules including remote options.