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Senior SIU Analyst - FWA Detection

ICONMA

Role overview

Qualifications

  • 4+ years FWA investigative experience, payer-side preferred
  • Direct exposure to claims coding logic (CPT/HCPCS, ICD-10, DRG/APC)
  • Certification required: AHFI, CFE, or CPC/CPMA
  • Bachelor's degree, or 7+ years relevant experience in lieu

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
  • Partner with product and data science teams to translate investigative judgment into refined detection rules
  • Present findings clearly to non-investigator audiences (product, compliance, leadership)

Key facts

Hard skills

Other skills

  • Communication
  • Presentations
  • Problem Solving

About the company

ICONMA logo

ICONMA

Management Consulting

We provide Professional Staffing Services & Project-Based Solutions for a broad range of Fortune 500 organizations. ICONMA is a certified Woman-Owned staffing company and was founded in 2000. ICONMA’s corporate headquarters is in Troy, Michigan, and has 15+ locations worldwide. What makes ICONMA stand out in a fiercely competitive industry? *We provide integrated, full lifecycle services across a broad range of business and technical platforms. *No single company can duplicate our full range of staffing and permanent recruiting services nationwide. *Proven track record of attracting and retaining exceedingly skilled professional workers in a highly competitive market. SERVICES OFFERED Staff Augmentation (Contract, Contract to Hire, Direct Hire, Single Source) Data Analysis Project-Based Services & Solutions Hire Train Deploy Service Model Offshore Staff Augmentation Payroll Services AREAS OF EXPERTISE - Information Technology - Engineering - Business Professional - Accounting/Finance - Admin/Clerical/Call Center - Healthcare/Clinical/Scientific - Marketing/Creative mail linkedin@iconma.com Phone (888) 451-2519 Website http://www.iconma.com

Company details

Company typeLarge
IndustryManagement Consulting
Company size1001 - 5000

Links

Website LinkedIn See all jobs

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Job 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
 
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MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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