Fraud Analyst Jobs in Riverside, CA (NOW HIRING)

At Stout, we're dedicated to exceeding expectations in all we do - we call it Relentless Excellence . Both our client service and culture are second to none, stemming from our firmwide embrace of our core values: Positive and Team-Oriented, Accountable, Committed, Relationship-Focused, Super-Responsive, and being Great communicators. Sound like a place you can grow and succeed? Read on to learn more about an exciting opportunity to join our team.

Impact You'll MakeThis section outlines the key outcomes and contributions expected from the role. It highlights how your work will shape engagements, support clients, and drive value across Stout's Healthcare Consulting practice.

• Contribute to complex healthcare consulting engagements involving coding audits, disputes, claims analysis, and investigations.
• Deliver high-quality, accurate coding analysis that informs client decisions, regulatory responses, and litigation support.
• Identify risks related to billing, coding, and reimbursement, including potential fraud, waste, and abuse.
• Support the development of defensible findings and recommendations through detailed documentation and analysis.
• Enhance Stout's reputation for excellence by applying deep expertise in inpatient coding, reimbursement systems, and compliance.

What You'll DoHere, you'll find the core responsibilities and day-to-day duties of the role. These tasks are designed to help you achieve desired outcomes while supporting team and organizational goals.

• Perform detailed reviews of inpatient medical records to assess accuracy of ICD-10-CM/PCS coding and alignment with clinical documentation.
• Analyze coding, billing, and reimbursement practices across engagements involving audits, disputes, and investigations.
• Support forensic analyses to identify compliance risks, inefficiencies, and reimbursement discrepancies.
• Assist in audits, regulatory reviews, and litigation support by gathering evidence, analyzing issues, and contributing to reporting.
• Evaluate DRG/APR-DRG/APC assignments and reimbursement implications based on clinical documentation.
• Collaborate with internal teams, clients, and legal counsel to support engagement objectives.
• Prepare clear, well-structured reports, analyses, and client-ready deliverables summarizing findings and recommendations.
• Monitor coding trends, denials, billing edits, and regulatory updates to inform analyses and engagement insights.
• Contribute to internal knowledge sharing and continuous improvement within the Healthcare Consulting practice.

What You BringThis section details the skills, qualifications, and experience needed to excel in the role.

• Bachelor's degree in Health Information Management or related field (or equivalent experience).
• Minimum of five (5) years of recent acute-care inpatient facility coding experience.
• Strong experience with DRG and PCS coding, including auditing; denials experience preferred.
• Active coding credential required (CCS, CIC, RHIT, or RHIA).
• Knowledge of MS-DRG, APR-DRG, APC methodologies and reimbursement frameworks.
• Experience reviewing clinical documentation for accuracy, compliance, and reimbursement optimization.
• Familiarity with healthcare regulatory frameworks (e.g., CMS, HIPAA, False Claims Act).
• Proficiency in Microsoft Office (Excel, Word, PowerPoint); experience with data visualization tools is a plus.
• Strong analytical, problem-solving, and written/verbal communication skills.

How You'll ThriveThis section highlights the competencies and behaviors that will set you up for success in this role and align with Stout's culture.

• Analytical and Detail-Oriented: Ability to interpret complex clinical and coding data and draw well-supported conclusions.
• Collaborative and Client-Focused: Works effectively with cross-functional teams and builds strong client relationships.
• Accountable and Proactive: Takes ownership of work, manages priorities, and delivers high-quality results on time.
• Adaptable and Curious: Thrives in a fast-paced consulting environment and continuously learns new regulations and methodologies.
• Quality and Integrity Driven: Demonstrates commitment to ethical coding practices and compliance standards.
• Aligned with Stout Values: Embodies Relentless Excellence through teamwork, responsiveness, and strong communication.

Why Stout?
At Stout, we offer a comprehensive Total Rewards program with competitive compensation, benefits, and wellness options tailored to support employees at every stage of life.
We foster a culture of inclusion and respect, embracing diverse perspectives and experiences to drive innovation and success. Our leadership is committed to inclusion and belonging across the organization and in the communities we serve.
We invest in professional growth through ongoing training, mentorship, employee resource groups, and clear performance feedback, ensuring our employees are supported in achieving their career goals.
Stout provides flexible work schedules and a discretionary time off policy to promote work-life balance and help employees lead fulfilling lives.
Learn more about our benefits and commitment to your success.

https://www.stout.com/en/careers/benefits

The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform the job.

Stout is an Equal Employment Opportunity.All qualified applicants will receive consideration for employment on the basis of valid job requirements, qualifications and merit without regard to race, color, religion, sex, national origin, disability, age, protected veteran status or any other characteristic protected by applicable local, state or federal law.

Stout is required by applicable state and local laws to include a reasonable estimate of the compensation range for this role. The range for this role considers several factors including but not limited to prior work and industry experience, education level, and unique skills. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. It is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.

A reasonable estimate of the current range is $60,000.00 - $130,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan. Information about benefits can be found here - https://www.stout.com/en/careers/benefits.