Senior Special Investigations Unit Medical Reviewer

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 minimal supervision, the Senior Special Investigations Unit Medical Reviewer (Senior SIU Medical Reviewer) performs clinical and complex 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). The Senior SIU Medical Reviewer will provide guidance and mentorship to SIU Medical Reviewers.

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 five (5) years of experience performing medical reviews in support of a healthcare SIU * Bachelor's degree in medical billing or medical coding, nursing, healthcare administration, or related field from an accredited institution required * Certified Professional Coder (CPC) required * One of the following licenses required: 1.Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians 2.