Minnesota Licensed Clinical Investigator

Key responsibilities: Conducts quality audits of clinical review cases for CPT, HCPCS, and modifiers in a telecommuting environment Determines the accuracy of medical coding and provides payment recommendations for pre-payment claims Identifies billing patterns and trends, ensuring adherence to compliance policies and managing daily case review assignments

Required qualifications: High School Diploma/GED Certified Coder (AHIMA or AAPC) or licensed Nurse (RN, LPN) with medical record auditing and coding/billing experience 2+ years of experience as a certified coder with CPT/HCPCS/ICD coding experience or as a licensed nurse with relevant experience 1+ years of experience in a metric-driven team environment Intermediate to advanced knowledge of health insurance business and regulatory guidelines