Clinical Investigator I (Special Investigation Unit)

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This position is remote nationwide. Ideal candidate will be RN or LPN with coding experience, preferably someone who has worked for an insurance company in a Special Investigations Unit (SIU) or fraud department. Ideal background includes reviewing medical records for fraud investigations, as well as experience from a specialist physician’s office focused on record review and documentation quality. Experience as a Documentation Improvement Specialist is also a strong fit. Position Purpose: Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards. Education/Experience: Associate's Degree related field or equivalent experience preferred 2+ years related clinical experience in the field of obtained license required - Perform retrospective and prepay...