Special Investigations Unit Medical Reviewer

2 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.

Pay: $71,572.80 - $93,038.40 per year

**Benefits**:

- 401(k)
- 401(k) matching
- 457(b)
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Paid time off
- Parental leave
- Professional development assistance
- Referral program
- Tuition reimbursement
- Vision insurance

Schedule:

- 8 hour shift
- Day shift
- Monday to Friday

Application Question(s):

- This position requires onsite work in Rancho Cucamonga, Tu-Th with remote flexibility on Mondays and Fridays. Standard business hours are Mon-Fri, 8am - 5pm. Are you fine with this schedule?

**Education**:

- Bachelor's (required)

**Experience**:

- medical rcord review and claims: 2 years (required)

Ability to Relocate:

- Rancho Cucamonga, CA 91730: Relocate before starting work (required)

Work Location: Hybrid remote in Rancho Cucamonga, CA 91730

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