Jessica Fisher

The Special Investigative Unit (SIU) Investigator III is responsible for conducting medium to highly complex reviews into suspected or actual healthcare fraud, waste, or abuse with respect to provider, pharmacy, employee, member, and broker interactions involving the full range of products at Presbyterian.

• This includes the identification, investigation, prevention , and reporting of fraudulent, wasteful, and/or abusive billing and/or coding practices and/or patterns.
• Requesting and reviewing medical record documentation to determine if services billed were rendered and/or appropriate based on documentation; interviewing suspect(s) and/or witness(es) with knowledge of the suspect and/or actual fraud, waste, or abuse; coordination of recovery of overpayments related to coding/representation of services and appropriate medical record documentation requirements.

• Assigned appropriate medical codes to patient records for billing and insurance purposes
• Reviewed and audited medical documentation to ensure accuracy and compliance with coding guidelines
• Maintained up-to-date knowledge of coding regulations and industry changes
• Reviewed medical records and assigned appropriate codes to diagnoses, treatments, procedures and services rendered by healthcare providers
• Analyzed patient data for accuracy and completeness of information
• Researched coding guidelines and regulations to ensure accurate coding practices
• Assigned ICD-10 and CPT codes for billing purposes
• Educated staff members on proper billing and coding techniques according to industry standards

• Organized and maintain patient medical records
• Performed data entry and assured accuracy of patient information
• Assisted in resolving patient complaints related to account balances, insurance coverage and payment plans
• Researched discrepancies in patient accounts to determine appropriate resolution