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 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

One of the following licenses preferred

Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN

Key Qualifications

Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail

Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary

Hybrid

USD $34.14 - USD $39.57 /Hr.