Clinical Investigator I (special Investigation Unit)
Centene
Multiple Locations, US
$56,200.00 - $101,000.00 py; not specified; not sp...
Hybrid
Audit medical records
Analyze claims data
Identify billing patterns
Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards
Job Summary
Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards.
Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Matching Summary
Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards.
Salary
$56,200.00 - $101,000.00 per year; Not specified; Not specified
Skills & Requirements
Must-have
Audit medical records
Analyze claims data
Identify billing patterns
Investigate provider billing
Nice-to-have
Transforming communities
Competitive benefits
Fresh perspective on flexibility
Key Requirements
Associate's Degree or equivalent experience
2+ years clinical experience
Coding certification required
RN, LPC, LPN, LCSW, LMHC, PT, OT, or ST license required