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Job Description

-Triage and prioritize leads/member complaints from internal sources.

-Review and assess incoming referrals

-Assist in the investigation of potential fraud, waste, and abuse.

-Conduct research in support of an investigation.

-Collect and evaluate potential suspicious patterns in claims data, provider enrollment data, and other sources to refer to Investigator for investigation or settlement.

-Assures accurate reimbursement is obtained and coding practices are compliant.

-Maintain comprehensive case files.

-Participates in special projects as required.

-Pay rate between $20-40/hr

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Skills and Requirements

-2+ years in medical coding, insurance billing, internal/ external audit, claims investigations, etc.

-Must have a Professional Coder certification

-Must have wonderful communication due to all of the teams and contacts this person will be communicating with

-Microsoft Excel, Word, Access, and Outlook experience -Bachelor's Degree in related field