Investigator, Coding SIU
Molina Healthcare Albany, New York; Everett, Washington; New York; Washington; Wisconsin; Ohio; Florida; Nebraska; Utah; Idaho; Texas; Michigan; Georgia; Kentucky; New Mexico; Iowa; Omaha, Nebraska; Fort Worth, Texas; Ann Arbor, Michigan; Detroit, Michigan; Bellevue, Washington; Seattle, Washington; Meridian, Idaho; Owensboro, Kentucky; Louisville, Kentucky; Sioux City, Iowa; Savannah, Georgia; Scottsdale, Arizona; Orem, Utah; Salt Lake City, Utah; Sterling Heights, Michigan; Spokane, Washington; Jacksonville, Florida; Macon, Georgia; Buffalo, New York; Grand Island, Nebraska; Dayton, Ohio; Idaho Falls, Idaho; Cincinnati, Ohio; Roswell, New Mexico; West Valley City, Utah; Racine, Wisconsin; Milwaukee, Wisconsin; Syracuse, New York; New York, New York; Covington, Kentucky; Davenport, Iowa; Des Moines, Iowa; Cedar Rapids, Iowa; Phoenix, Arizona; Caldwell, Idaho; Orlando, Florida; Yonkers, New York; Lexington-Fayette, Kentucky; Cleveland, Ohio; Columbus, Ohio; Mesa, Arizona; Santa Fe, New Mexico; Albuquerque, New Mexico; Las Cruces, New Mexico; Layton, Utah; St. Petersburg, Florida; Madison, Wisconsin; Boise, Idaho; Miami, Florida; Rochester, New York; Iowa City, Iowa; Austin, Texas; Dallas, Texas; Houston, Texas; Rio Rancho, New Mexico; Provo, Utah; Warren, Michigan; Tacoma, Washington; Nampa, Idaho; Lincoln, Nebraska; Kearney, Nebraska; Augusta, Georgia; Tucson, Arizona; San Antonio, Texas; Grand Rapids, Michigan; Vancouver, Washington; Tampa, Florida; Bowling Green, Kentucky; Bellevue, Nebraska; Akron, Ohio; Columbus, Georgia; Chandler, Arizona; Atlanta, Georgia; Green Bay, Wisconsin; Kenosha, Wisconsin Job ID 2031337JOB DESCRIPTION
Job Summary
The SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information from a tip, member benefits, and medical records to document relevant findings of a post pay clinical review. This position manages documents and prioritizes case load to ensure timely turn around. This position ensures adherence to state and federal policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or for payment recovery.
KNOWLEDGE/SKILLS/ABILITIES
- Reviews post pay claims with corresponding medical records to determine accuracy of claims payments.
- Review of applicable policies, CPT guidelines, and provider contracts.
- Devise clinical summary post review.
- Communicate and participate in meetings related to cases.
- Critical thinking, problem solving and analytical skills.
- Ability to prioritize and manage multiple tasks.
- Proven ability to work in a team setting.
- Excellent oral and written communication skills and presentation skills.
JOB QUALIFICATIONS
Required Education
High School Diploma / GED (or higher)
Required Experience
- 3+ years CPT coding experience (surgical, hospital, clinic settings) or 5+ years of experience working in a FWA / SIU or Fraud investigations role for New Jersey/New York location
- Thorough knowledge of PC based software including Microsoft Word (edit/save documents) and Microsoft Excel (edit/save spreadsheets, sort/filter)
Required License, Certification, Association
Licensed registered nurse (RN), Licensed practical nurse (LPN) and/or Certified Coder (CPC, CCS, and/or CPMA)
Preferred Education
Bachelor's degree (or higher)
Preferred Experience
- 2+ years of experience working in the group health business preferred, particularly within claims processing or operations.
- A demonstrated working knowledge of Local, State & Federal laws and regulations pertaining to health insurance, investigations & legal processes (Commercial insurance, Medicare, Medicare Advantage, Medicare Part D, Medicaid, Tricare, Pharmacy, etc.)
- Experience with UNET, Comet, Macess/CSP, or other similar claims processing systems.
- Demonstrated ability to use MS Excel/Access platforms working with large quantities of data to answer questions or identify trends and patterns, and the ability to present those findings.
Preferred License, Certification, Association
- AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred
- Certified Fraud Examiner and/or AHFI professional designations preferred
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $21.82 - $51.06 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 06/17/2025ABOUT OUR LOCATION
View Map- Field Family Nurse Practitioner (Bakersfield, CA) Bakersfield California, McFarland California, Taft California, Salt Lake City Utah, Cincinnati Ohio, Cedar Rapids Iowa, Las Cruces New Mexico, Wisconsin, Shafter California, Lamont California, Everett Washington, Provo Utah, Omaha Nebraska, Bowling Green Kentucky, Spokane Washington, Florida, Lincoln Nebraska, Ann Arbor Michigan, Buffalo New York, Sterling Heights Michigan, New York, Owensboro Kentucky, San Antonio Texas, Vancouver Washington, Nampa Idaho, Lexington-Fayette Kentucky, Boise Idaho, St. Petersburg Florida, Miami Florida, Savannah Georgia, Jacksonville Florida, Scottsdale Arizona, Green Bay Wisconsin, Akron Ohio, Grand Rapids Michigan, Tampa Florida, Grand Island Nebraska, Macon Georgia, Covington Kentucky, Texas, Warren Michigan, Kentucky, Georgia, Phoenix Arizona, Cleveland Ohio, Chandler Arizona, Des Moines Iowa, Racine Wisconsin, Albany New York, Washington, Nebraska, Fort Worth Texas, Tucson Arizona, Milwaukee Wisconsin, Davenport Iowa, Iowa City Iowa, Santa Fe New Mexico, Houston Texas, Kearney Nebraska, Caldwell Idaho, Rochester New York, Iowa, Louisville Kentucky, Tacoma Washington, Dayton Ohio, Meridian Idaho, Kenosha Wisconsin, Detroit Michigan, Albuquerque New Mexico, Dallas Texas, Bellevue Nebraska, Rio Rancho New Mexico, Yonkers New York, Orem Utah, Syracuse New York, Mesa Arizona, Idaho Falls Idaho, Bellevue Washington, Orlando Florida, Austin Texas, Columbus Ohio, Atlanta Georgia, Madison Wisconsin, New Mexico, Augusta Georgia, Idaho, Utah, Columbus Georgia, Sioux City Iowa, Roswell New Mexico, Ohio, Layton Utah, West Valley City Utah, Michigan 06/17/2025
- Specialist, Medicare Member Engagement - Remote in Pacific Time Zone Warren Michigan, Kenosha Wisconsin, Orem Utah, St. Petersburg Florida, Madison Wisconsin, Layton Utah, Bowling Green Kentucky, Texas, Bellevue Nebraska, Dallas Texas, Omaha Nebraska, Ann Arbor Michigan, Michigan, Washington, Spokane Washington, Everett Washington, Austin Texas, Columbus Ohio, Cedar Rapids Iowa, Grand Rapids Michigan, Chandler Arizona, Phoenix Arizona, Iowa City Iowa, Akron Ohio, Savannah Georgia, Kentucky, Iowa, New York, Sioux City Iowa, Idaho Falls Idaho, Provo Utah, Milwaukee Wisconsin, Vancouver Washington, Fort Worth Texas, Des Moines Iowa, Roswell New Mexico, Kearney Nebraska, Salt Lake City Utah, Rio Rancho New Mexico, Wisconsin, Florida, Caldwell Idaho, Augusta Georgia, Orlando Florida, Detroit Michigan, Mesa Arizona, Tampa Florida, Cleveland Ohio, Tacoma Washington, Racine Wisconsin, Boise Idaho, West Valley City Utah, Scottsdale Arizona, Nebraska, Ohio, Georgia, Idaho, Nampa Idaho, Macon Georgia, Bellevue Washington, Meridian Idaho, Cincinnati Ohio, Santa Fe New Mexico, Albuquerque New Mexico, Las Cruces New Mexico, Green Bay Wisconsin, San Antonio Texas, Lincoln Nebraska, Atlanta Georgia, Grand Island Nebraska, Tucson Arizona, Sterling Heights Michigan, Louisville Kentucky, Jacksonville Florida, New Mexico, Utah, Buffalo New York, Miami Florida, Lexington-Fayette Kentucky, Syracuse New York, Covington Kentucky, Davenport Iowa, Dayton Ohio, Houston Texas, Albany New York, Owensboro Kentucky, Yonkers New York, Columbus Georgia, Rochester New York 06/17/2025
- Specialist, Medicare Member Engagement - Remote in Eastern Time Zone Kearney Nebraska, Grand Rapids Michigan, Green Bay Wisconsin, Utah, Racine Wisconsin, New Mexico, Georgia, Las Cruces New Mexico, Boise Idaho, Savannah Georgia, Austin Texas, Grand Island Nebraska, Macon Georgia, Warren Michigan, Phoenix Arizona, Milwaukee Wisconsin, New York, St. Petersburg Florida, Sterling Heights Michigan, Kenosha Wisconsin, Idaho, Jacksonville Florida, Fort Worth Texas, Des Moines Iowa, Tucson Arizona, Roswell New Mexico, Orem Utah, Albuquerque New Mexico, Ann Arbor Michigan, Detroit Michigan, Orlando Florida, Washington, Layton Utah, Cincinnati Ohio, Cedar Rapids Iowa, Cleveland Ohio, Santa Fe New Mexico, Houston Texas, Everett Washington, Nampa Idaho, Kentucky, Iowa City Iowa, Bellevue Washington, Owensboro Kentucky, Provo Utah, Dallas Texas, Chandler Arizona, Tampa Florida, Dayton Ohio, Bowling Green Kentucky, Louisville Kentucky, Columbus Georgia, Texas, Wisconsin, Syracuse New York, Spokane Washington, Albany New York, Bellevue Nebraska, Miami Florida, Idaho Falls Idaho, Ohio, Nebraska, San Antonio Texas, Mesa Arizona, Columbus Ohio, Augusta Georgia, Madison Wisconsin, Scottsdale Arizona, West Valley City Utah, Sioux City Iowa, Covington Kentucky, Iowa, Florida, Caldwell Idaho, Davenport Iowa, Meridian Idaho, Rio Rancho New Mexico, Vancouver Washington, Buffalo New York, Salt Lake City Utah, Lexington-Fayette Kentucky, Lincoln Nebraska, Tacoma Washington, Omaha Nebraska, Rochester New York, Atlanta Georgia, Yonkers New York, Michigan, Akron Ohio 06/17/2025
- Care Connections Representative - (Must be Bilingual in Spanish) 10:30 - 7PM PST Hours Davenport Iowa, Dallas Texas, Iowa City Iowa, Nampa Idaho, Washington, Bellevue Nebraska, Caldwell Idaho, Owensboro Kentucky, Phoenix Arizona, Provo Utah, Cleveland Ohio, Syracuse New York, Vancouver Washington, Des Moines Iowa, Ann Arbor Michigan, Warren Michigan, Chandler Arizona, Idaho, Utah, West Valley City Utah, Layton Utah, Tucson Arizona, Miami Florida, Grand Rapids Michigan, Lincoln Nebraska, Michigan, Bowling Green Kentucky, Idaho Falls Idaho, Milwaukee Wisconsin, Spokane Washington, Everett Washington, Louisville Kentucky, Columbus Ohio, Yonkers New York, Madison Wisconsin, St. Petersburg Florida, Sterling Heights Michigan, Sioux City Iowa, Kentucky, Georgia, Orem Utah, Houston Texas, Fort Worth Texas, Buffalo New York, Tacoma Washington, Green Bay Wisconsin, Omaha Nebraska, Meridian Idaho, Dayton Ohio, Akron Ohio, New York, Nebraska, New Mexico, Boise Idaho, Savannah Georgia, Scottsdale Arizona, Cedar Rapids Iowa, Rochester New York, Detroit Michigan, Salt Lake City Utah, Racine Wisconsin, Lexington-Fayette Kentucky, Iowa, Austin Texas, Jacksonville Florida, Grand Island Nebraska, Macon Georgia, Santa Fe New Mexico, Kearney Nebraska, Augusta Georgia, Orlando Florida, Wisconsin, Ohio, Florida, Bellevue Washington, Albuquerque New Mexico, Mesa Arizona, Tampa Florida, Cincinnati Ohio, Rio Rancho New Mexico, Columbus Georgia, Covington Kentucky, Las Cruces New Mexico, Texas, San Antonio Texas, Albany New York, Roswell New Mexico, Kenosha Wisconsin, Atlanta Georgia 06/17/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs