Certified Professional Coder, Special Investigations Unit (Aetna SIU)

The Certified Professional Coder will perform medical claim reviews to ensure compliance with coding practices through comprehensive record review for various healthcare providers. Responsibilities include determining correct coding and appropriate documentation, ensuring state, federal, and company requirements are met, and recognizing concerning billing patterns or trends. The role involves conducting detailed medical record reviews, providing written summaries of findings, articulating findings to various stakeholders including investigators and law enforcement, and discussing cases with Medical Directors. Additionally, the coder will assist with investigative research related to coding questions and policies, identify potential billing errors, abuse, and fraud, and identify opportunities for savings. Maintaining appropriate records and documentation, and the ability to travel for meetings and potential testimony are also key responsibilities.