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Special Investigations Unit Medical Reviewer

5 months ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

What you can expect 

 

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

 

Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP’s Compliance Special Investigations Unit (SIU). 


Perks

 

 

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

 

  • CalPERS retirement
  • 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account – Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities

 

Education & Experience

 

  • A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting
  • Bachelor’s degree in medical billing or medical coding, nursing, healthcare administration, or other related field from an accredited institution required
  • Certified Professional Coder (CPC) required
  • One of the following licenses preferred
  • Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians
  • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN

 

Key Qualifications

  • Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail
  • Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary

 

Start your journey towards a thriving future with IEHP and apply TODAY


Hybrid


USD $34.14 - USD $39.57 /Hr.