Clinical Investigator II

Job Summary

A company is looking for a Clinical Investigator II to audit medical records and identify inappropriate billing practices.

Key Responsibilities

• Perform complex retrospective and prepayment reviews of medical records to identify potential abuse and fraud
• Investigate and analyze provider billing patterns to recommend payment based on medical records and regulatory guidelines
• Consult with investigators and perform onsite audits to assess providers and their practices

Required Qualifications

• Associate's degree in Nursing, Counseling, or related field preferred
• Coding Certification and 4+ years of medical coding experience, or relevant clinical license with 4+ years of experience
• Experience in provider education preferred
• Experience in a managed care organization preferred
• Experience in medical record auditing preferred