Track progress against substantiation-rate and findings-volume targets (set once POC window and initial data are confirmed). Our Client, an American Technology company, is looking for a Senior SIU Analyst - FWA Detection for their Bowie, MD location.
Numbers & Facts
Location
MD
Description
Our Client, an American Technology company, is looking for a Senior SIU Analyst - FWA Detection for their Bowie, MD location.
Responsibilities:
Review claims flagged by detection logic and determine true positive vs. false positive
Articulate the specific billing pattern, code combination, or provider behavior driving each call
Carry select flagged leads through to a documented, substantiated finding
Partner with product and data science teams to translate investigative judgment into refined detection rules
Track progress against substantiation-rate and findings-volume targets (set once POC window and initial data are confirmed)
Write a findings/recommendation memo - scale, iterate, or kill - for internal stakeholders
Present findings clearly to non-investigator audiences (product, compliance, leadership)
Requirements:
4+ years FWA investigative experience, payer-side preferred
Direct exposure to claims coding logic (CPT/HCPCS, ICD-10, DRG/APC)
Must have prior experience starting cold on a live data feed
Comfortable working from partial/imperfect data - sample extracts, not a finished production system
Certification required: AHFI, CFE, or CPC/CPMA
SQL or equivalent self-serve query ability
Familiarity with edit/rules logic (e.g., NCCI edits)
Bachelor's degree, or 7+ years relevant experience in lieu