Ohio Licensed SIU RN Investigator

A company is looking for an Investigator, SIU RN. Key Responsibilities Perform medical record audits to verify service documentation and coding accuracy Conduct interviews with providers and health plan members to investigate potential fraud, waste, or abuse Generate detailed audit reports and provide education on appropriate coding practices Required Qualifications Graduate from an Accredited School of Nursing Five years of clinical nursing experience with broad clinical knowledge Five years of experience in medical review and coding/billing audits Active, unrestricted State Registered Nursing (RN) license in good standing Knowledge of medical terminology and coding requirements (CPT, ICD-9, HCPCS, DRG)

Mar 3, 2025 - 19:32

A company is looking for an Investigator, SIU RN. Key Responsibilities Perform medical record audits to verify service documentation and coding accuracy Conduct interviews with providers and health plan members to investigate potential fraud, waste, or abuse Generate detailed audit reports and provide education on appropriate coding practices Required Qualifications Graduate from an Accredited School of Nursing Five years of clinical nursing experience with broad clinical knowledge Five years of experience in medical review and coding/billing audits Active, unrestricted State Registered Nursing (RN) license in good standing Knowledge of medical terminology and coding requirements (CPT, ICD-9, HCPCS, DRG)