SIU Code Auditor
Worcester, MA · On-site
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services ...
Worcester, MA · On-site
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services ...
Worcester, MA · On-site
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services ...
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services ...
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
Clinical Provider Auditor II - Payment Integrity SIU Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering ...
The RN Clinical Auditor will obtain and review medical record documentation to validate authorized ... This role works collaboratively with the entire SIU team and communicates with internal business ...
The RN Clinical Auditor will obtain and review medical record documentation to validate authorized ... This role works collaboratively with the entire SIU team and communicates with internal business ...
The RN Clinical Auditor will obtain and review medical record documentation to validate authorized ... This role works collaboratively with the entire SIU team and communicates with internal business ...
The RN Clinical Auditor will obtain and review medical record documentation to validate authorized ... This role works collaboratively with the entire SIU team and communicates with internal business ...
Dayton, OH · On-site
The Special Investigations Unit (SIU) Investigator I is responsible for comprehensive review ... Minimum of eighteen (18) months experience in medical coding, billing, auditing, data analytics, or ...
Dayton, OH · On-site
The Special Investigations Unit (SIU) Investigator I is responsible for comprehensive review ... Minimum of eighteen (18) months experience in medical coding, billing, auditing, data analytics, or ...
Dayton, OH · On-site
The Special Investigations Unit (SIU) Investigator I is responsible for comprehensive review ... auditing, data analytics, or related field is required Competencies, Knowledge, and Skills:
Dayton, OH · On-site
The Special Investigations Unit (SIU) Investigator I is responsible for comprehensive review ... auditing, data analytics, or related field is required Competencies, Knowledge, and Skills:
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
Clinical Provider Auditor II - Payment Integrity SIU Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility ...
$38.5K - $48.7K
3% of jobs
$48.7K - $59K
11% of jobs
$59K - $69.2K
8% of jobs
$72.5K is the 25th percentile. Wages below this are outliers.
$69.2K - $79.4K
11% of jobs
The median wage is $88.3K / yr.
$79.4K - $89.6K
20% of jobs
$89.6K - $99.9K
13% of jobs
$108K is the 75th percentile. Wages above this are outliers.
$99.9K - $110.1K
12% of jobs
$110.1K - $120.3K
11% of jobs
$120.3K - $130.5K
9% of jobs
$130.5K - $140.8K
3% of jobs
$140.8K - $151K
0% of jobs
$38.5K
$92.8K
$151K
| Aspect | Siu Auditor | Insurance Auditor |
|---|---|---|
| Required Credentials | Certifications like CPA, CIA often preferred | Certifications such as CPCU, ARM may be advantageous |
| Work Environment | Government agencies, corporate compliance teams | Insurance companies, third-party claims departments |
| Employer & Industry Usage | Used in regulatory and compliance contexts | Common in insurance industry for claims and policy audits |
| Search & Comparison Intent | Understanding audit roles in compliance | Evaluating insurance-specific audit functions |
The Siu Auditor primarily focuses on compliance and regulatory audits within organizations, often in government or corporate settings. In contrast, an Insurance Auditor specializes in reviewing insurance claims, policies, and underwriting processes. While both roles involve auditing skills and certifications, their industries and specific responsibilities differ. Understanding these distinctions helps job seekers identify the right career path based on their credentials and interests.

7.3
Based on 13 frontline employees who took The Breakroom Quiz
About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose:
The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services, and may include some behavioral health care services to identify potential over-payments and suspected fraud waste and abuse. Serve as a clinical and code liaison for fraud, waste and abuse team while identifying areas of vulnerability and risk.
Primary Job Responsibilities (include duties that represent 5% or more of employee's time)
The Internal Audit Department (IA) at Fallon Health serves as the company’s designated Special Investigation Unit (SIU) for fraud, waste, and abuse (FWA) activity. The department reports administratively to the Chief Compliance Officer and functionally to the Audit & Compliance Committee, and it plays a central role in detecting, reviewing, and addressing potential fraud, waste, and abuse.
In this role, the SIU Code Auditor is responsible for reviewing medical records, identifying coding and billing concerns, supporting investigations, and communicating findings and recommendations to internal and external stakeholders. This also includes tracking of cases assigned and maintaining documentation to department standards and assisting with reports due to both internal and external partners.
Bachelor’s degree preferred or equivalent experience, and prior experience in healthcare
License/Certifications
Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) is required. Clinical Experience is preferred.
Certified Evaluation and Management Coder (CEMC) or Certified Professional Medical Auditor (CPMA) are a plus.
Experience:
,,Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $87,500 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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