Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The SIU Investigator performs reviews of claim lines flagged by Community's SIU and 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.
- Bachelor's degree required.
- Certification in Coding and Medical Billing, Accredited Health Care Fraud Investigator (AHFI) or Certified Fraud Investigator (CFE) certification required
- Five years experience in Healthcare coding in the medical industry directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing.
- Solid Knowledge of Medicare, Medicaid and commercial coding practices.
- Thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS) and International Classification of Diseases, and Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version)
- Above Average Verbal communication skills
- Writing /Composing (Correspondence / Reports )
- Medical Terminology
- Medical coding procedure expertise (CPT, ICD-10, HCPCS)
- Advanced Training Specialty: Required: Certification in Coding and Medical Billing
Benefits and EEOC
Harris Health System benefits program is designed to provide you with more flexibility and choices in meeting your specific needs. Harris Health System benefits program allows you to protect your income in case of illness, death and disability, and to help you save for retirement.
It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process.