Job Description

We are seeking a Special Investigative Unit Analyst for a full-time position with our client, a managed care organization located in Indianapolis. This is a hybrid role requiring two (2) days per week in the office on Tuesdays and Wednesdays.

The Special Investigative Unit Analyst is responsible for supporting compliance and investigative technology needs across the organization. This role plays a critical part in detecting and preventing fraud, waste, and abuse, while ensuring compliance with legal and regulatory requirements related to Special Investigation Units. The SIU Analyst collaborates closely with Legal and Compliance teams to investigate and mitigate potential fraud risks within healthcare billing and provider practices.

Resumes may be submitted directly or via email to hr@roisg.com.

Responsibilities:

• Detect fraudulent activities and collaborate with Legal to determine investigation strategies.
• Apply knowledge of healthcare billing including IHCP rules, UB Editor, HCPCS, CPT, DRG, and Per Diem billing.
• Utilize anti-fraud technologies to support investigative efforts.
• Analyze CPT, ICD-10, and HCPCS codes to identify fraud schemes.
• Complete thorough and timely investigations, collecting and organizing all relevant documentation and evidence.
• Conduct onsite provider office reviews and calculate overpayments when applicable.
• Prepare detailed audit and investigative reports including summaries of findings and supporting evidence.
• Maintain accurate records in case tracking systems and monthly reporting tools.
• Provide regular updates to leadership and stakeholders.
• Testify in legal proceedings as required.
• Stay informed on current state and federal anti-fraud regulations.
• Develop and deliver fraud awareness training for Plan staff as needed.
• Assist in shaping and improving the organization's fraud prevention strategies and procedures.
• Perform other duties as assigned to support departmental operations.

Qualifications:

Required:

• Minimum three (3) years of experience in roles requiring analytical skills, including at least two (2) years in compliance or a related field.
• Two (2) years of coding experience with CPT, ICD, and HCPCS codes, and industry billing for CMS 1500 and UB04 claims.
• One (1) year of experience with SQL query development and maintenance.

Preferred:

• Bachelor’s degree in business, healthcare, or related field.
• Relevant certifications (e.g., RHIT, RHIA, CFE, CPC).
• Two (2) years of experience with HMO/PPO environments including claims, membership, or regulatory compliance.

About ROI Search Group:

ROI Search Group is a staffing and executive search firm based near Indianapolis, IN, specializing in direct hire, contract, and contract-to-hire placements, along with executive and specialized searches. Our proven methodology allows us to attract top talent while supporting candidates in their career progression. By aligning with the priorities of both clients and candidates, we create long-term, successful partnerships. At ROI Search Group, we are dedicated to providing exceptional staffing and executive search solutions that drive organizational growth and career advancement. We take pride in our commitment to excellence, integrity, and building meaningful professional connections.

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