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Special Investigation Unit Investigator
JOB SUMMARY: The Special Investigation Unit Investigator performs reviews of claim lines flagged by Community's SIU and Community's SIU Contractor. The SIU investigator will assist the SIU manager in gathering information from internal and external partners for investigations and audits. The SIU investigator will coordinate with internal and external resources in determining the appropriateness of codes found in administrative and medical claims and develop reports of findings and recommendations for the SIU function.JOB SPECIFICATIONS Essential Functions:Perform duties associated with SIU prepayment review.Perform duties associated with Provider self-audits.
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