Healthcare Fraud Shield Benefits Overview

Conducts healthcare fraud, waste, and abuse investigations by reviewing medical records and claims, validating coding and billing appropriateness, abstracting clinical and billing codes, analyzing client data, documenting claim findings, preparing reports, and supporting Special Investigations Unit clients. Requires maintaining knowledge of coding guidelines, healthcare regulations, privacy standards, and secure handling of protected health information.

Provides daily help desk and endpoint support for employees, including workstation, mobile device, account, Microsoft 365, and Intune administration. Manages onboarding and offboarding, user training, documentation, asset inventory, shipments, printers, conference rooms, badges, and physical access systems. Maintains Windows security compliance through patching and vulnerability remediation, supports VPN troubleshooting, and performs IT monitoring and audit activities. This on-site role also coordinates office technology and facilities-related support.

Perform routine medical coding audits comparing billed CPT, HCPCS, ICD-10, DRG and revenue codes to medical records, document findings, summarize reports, and maintain knowledge of coding guidelines and regulations while meeting productivity targets.