Senior Special Investigative Unit (SIU) Auditor (Healthcare Fraud & Coding)

Location: Mountlake Terrace, Washington, United States; hybrid

Salary: $69,600–$118,300 per year

Company

hirify.global provides healthcare coverage and services focused on improving customer and member outcomes.

What you will do

• Conduct retrospective and prospective audits of medical claims, provider billing, coding, and clinical documentation.
• Validate CPT, HCPCS, ICD-10-CM, DRG, modifier, and revenue code accuracy and reimbursement compliance.
• Analyze billing trends and data to investigate fraud, waste, abuse, improper reimbursement, and emerging risks.
• Develop fraud prevention strategies and support provider education, remediation, and corrective action.
• Prepare audit findings, overpayment determinations, investigative documentation, and leadership recommendations.
• Coordinate complex audits, collaborate with internal and external partners, provide affidavits or sworn testimony when needed, mentor junior auditors, and lead process improvements.

Requirements

• Bachelor’s degree in a related field or an equivalent combination of education and relevant experience.
• At least 5 years of healthcare coding, auditing, SIU, compliance investigation, claims analysis, appeals, provider dispute, or related experience.
• Active Certified Professional Coder (CPC) and Accredited Healthcare Fraud Investigator (AHFI) credentials.
• Advanced knowledge of coding methodologies, healthcare compliance requirements, and fraud, waste, and abuse indicators.
• Experience with SIU case management systems, SQL, Excel, data analytics, or audit tools.
• Strong analytical, problem-solving, communication, and presentation skills.

Nice to have

• Additional certification such as CPC-P, CPMA, CCS, CFE, or CHC.

Culture & Benefits

• Hybrid on-campus model with access to on-site resources, networking, and team engagement.
• Medical, vision, and dental coverage, life and disability insurance, and voluntary benefits including pet insurance.
• Retirement programs with a 401(k) employer match and a pension plan vested after three years.
• Paid time off, wellness resources, counseling, stress management, and mindfulness programs.
• Tuition assistance, commuter perks, free on-site parking, subsidized cafés, and an on-campus fitness and well-being center.