Prepay Coding Investigation Consultant (Remote)

!Prepay Coding Investigation Consultant **Remote Opportunity** We are seeking an experienced **Prepay Coding Investigation Consultant** to investigate and resolve potential healthcare **fraud, waste, and abuse (FWA)** involving medical providers. This role uses medical records, member benefits, tips, and investigative leads to identify and document findings while supporting coding accuracy and regulatory compliance. Key Responsibilities * Investigate potential healthcare fraud, waste, and abuse involving medical providers. * Review **medical records, member benefits, tips, and investigative leads**. * Analyze and document findings to support investigation conclusions. * Apply **CPT and ICD coding knowledge** to complex medical coding issues. * Provide coding guidance to investigators, particularly related to **CPT codes**. * Mentor and provide explanations and feedback on complex coding and investigative issues. * Collaborate with internal and external stakeholders to fulfill client requests. * Support internal and external projects and assigned performance goals. * Maintain compliance with applicable healthcare regulations, policies, and procedures. * Meet established productivity, quality, and performance metrics. Required Qualifications **Candidates must meet one of the following:** * **Licensed RN or LPN with coding credentials/certification**, **OR** * **Certified Coder with 3\+ years of coding experience** in surgical, hospital, and/or clinic settings. Required Skills * **CPT coding experience – Required** * **ICD coding experience – Required** * Strong medical coding knowledge * Strong critical\-thinking and analytical skills * Excellent problem\-solving and investigative skills * Strong attention to detail * Proficiency with PC\-based software and Microsoft Office * Ability to review and interpret medical records * Ability to communicate complex coding issues clearly * Ability to work independently while collaborating with internal and external teams Ideal Background Candidates with experience in **medical coding, auditing, healthcare investigations, surgical coding, hospital coding, clinic coding, claims review, or fraud/waste/abuse investigations** are encouraged to apply. How to Apply **Please send your resume to sandy.h@omegahms.com.** **Subject Line: Prepay Coding Investigation Consultant** Please ensure your resume clearly lists your **coding certification, CPT/ICD experience, and healthcare coding experience**. **Know someone who may be a great fit? Please share this opportunity with your professional network!** Pay: $41\.00 per hour Expected hours: 40\.0 per week Work Location: Remote