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Medical Reviewer

2 months ago

Rancho Cucamonga, California, United States Inland Empire Health Plan Full time
{"title": "Special Investigations Unit Medical Reviewer", "description": "Healing and Inspiring the Human Spirit

We are seeking a highly skilled Medical Reviewer to join our Special Investigations Unit (SIU) team at Inland Empire Health Plan (IEHP). As a Medical Reviewer, you will play a critical role in ensuring the accuracy and compliance of medical records and healthcare claims with federal and state regulations and contractual requirements.

Key Responsibilities:
  • Perform reviews of medical records and healthcare claims to identify coding errors and billing discrepancies
  • Substantiate or refute the accuracy of codes billed in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA)
  • Collaborate with the Compliance Special Investigations Unit (SIU) to investigate and resolve FWA cases
What We Offer:
  • A competitive salary with annual merit increase
  • A comprehensive benefits package, including medical, dental, and vision insurance
  • A 401(k) plan with employer matching
  • Flexible scheduling and remote work options
  • Professional development opportunities and career advancement
Requirements:
  • 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
  • Certified Professional Coder (CPC) certification required
Work Environment:

Our office is located in Rancho Cucamonga, CA, and we offer a hybrid remote work arrangement with two days of on-site work and three days of remote work.

Please note that this position requires relocation to Rancho Cucamonga, CA, prior to starting work.

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