Healthcare Coding Expert

About the role

Support a federal health programme by analysing claims data and producing fraud, waste and abuse referrals. Work within a team focused on reducing improper payments in healthcare data.

What you will do

• Carry out analytical work for the partnership programme, spotting referrals and leads from analytics
• Help develop analytic reports and drive outcome metrics tied to referrals shared with partners
• Review medical claims for accuracy, completeness and compliance with policies and coding rules
• Investigate fraud, waste and abuse schemes and research policies, coding guidelines and reimbursement criteria
• Take part in quality assurance so deliverables meet regulatory and industry standards
• Answer analytic questions from internal and external parties and may mentor junior staff

What they look for

• Bachelor degree or equivalent work experience
• Eight or more years analysing healthcare claims
• Certified Professional Coder or Certified Coding Specialist credential
• Expertise in medical terminology and coding systems such as ICD-10, CPT and HCPCS
• Experience in programme integrity and healthcare fraud, waste and abuse work, including audits and investigations
• Knowledge of insurance regulations, reimbursement methods and compliance rules, plus strong communication and Microsoft Office skills

Nice to have

• Certified Fraud Examiner or Accredited Healthcare Fraud Investigator designation