Fallon Health

Fallon Health seeks an SIU ICD10 Professional Coder to join the Healthcare Fraud, Waste and Abuse team in Worcester, MA. The role is hybrid with 2 days in office, focusing on auditing medical records for E&M, DME and other services to identify potential over-payments and fraud indicators. Responsibilities include coding audits, investigative support, pattern identification and collaboration with providers and clinical teams to ensure compliant billing. #J-18808-Ljbffr

Overview About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region....