You’ll need
Education
Associate or bachelor’s degree in a healthcare, science, or business related field preferred
Qualifications
✓2+ years of experience working with medical charts, clinical documentation, health insurance claims analysis or related experience.
✓Knowledge of CPT, HCPCS, and ICD‑10 coding and medical terminology.
✓Annual competencies as required by Aspirus and/or various regulatory agencies based on entity and/or job position.
or equivalent professional experience in clinical documentation, health information, or medical chart review. preferred
Experience in SIU, FWA investigations, or compliance within a payer or provider environment. preferred
Familiarity with CMS, Medicare, and commercial plan regulations preferred
Strong analytical and problem‑solving skills with the ability to interpret complex data sets. preferred
Excellent written and verbal communication skills for reporting and cross‑department collaboration. preferred
Proficiency with claims platforms and data tools such as Facets, ClaimsXten, Excel, or similar systems. preferred
Background in clinical case management or utilization review. preferred
Benefits
Full benefits packages available for part- and full-time statusTime away from work accrualRetirement plans availableWellness program for employees and their families
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About the role
The FWA Analyst plays a critical role in protecting the organization from improper billing, abusive practices, and potential fraud. This position conducts detailed reviews of medical claims, provider patterns, and member activity to identify anomalies and ensure compliance with regulatory, contractual, and clinical standards.