Coder-Senior Investigator

Are you a skilled and detail-oriented coder with a passion for investigating complex healthcare cases? Presbyterian Healthcare Services is seeking a Senior Investigator to join our team and utilize your expertise to uncover any potential coding errors or fraudulent activities. This role offers the opportunity to make a significant impact on the healthcare industry while working alongside a dedicated team. If you have a strong background in coding and a keen eye for detail, we would love to hear from you. Join us and help us continue to provide high-quality care to our community.

1. Conduct thorough investigations of complex healthcare cases to identify potential coding errors or fraudulent activities.
2. Utilize coding expertise and knowledge of industry regulations to accurately assess and determine the validity of healthcare claims.
3. Collaborate with cross-functional teams, including healthcare providers and legal professionals, to gather and analyze evidence.
4. Prepare detailed reports and presentations to communicate findings and recommendations to management.
5. Stay updated on industry trends, regulations, and coding practices to ensure the accuracy and effectiveness of investigations.
6. Develop and implement strategies to proactively identify and prevent potential coding errors or fraudulent activities.
7. Train and mentor junior investigators on coding practices and investigative techniques.
8. Maintain strict confidentiality and adhere to ethical standards while handling sensitive information.
9. Act as a liaison with external agencies, such as law enforcement and regulatory bodies, when necessary.
10. Participate in regular team meetings and provide input to improve processes and procedures.

According to JobzMall, the average salary range for a Coder-Senior Investigator is $60,000-$110,000 per year. This can vary depending on factors such as experience, location, and company size.

Presbyterian Healthcare Services is a private not-for-profit health care system and health care provider in the State of New Mexico. It owns and operates 8 hospitals in 7 New Mexico communities. It also operates Presbyterian Health Plan.