• The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines. • Work with SIU Investigators assisting in research, discuss to make appropriate coding determinations as needed • Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed • Compare information submitted on the claims to determine amount and nature of billable services as needed • Determines appropriateness of billing and reimbursement as needed • Documents findings for each claim line in a spreadsheet as needed • Summarize findings in a written report as needed • Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed • Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed • Perform data analysis and lead generation/data mining of client data as needed • Provide Subject Matter Expertise and SIU support to clients as needed • Comply with Privacy and Security standards • Understands and complies with all company Privacy and Security standards

• Provides billing support for the Sandstone Care billing team. Responsible for inputting data into multiple systems related to client information, insurance information, attendance and coding for services rendered. • Coordinates with billing team to immediately resolve billing inconsistencies and delinquent data. • Responsible for verification of benefits, billing data, claims submission, claim corrections, claim re-submissions, claim follow up and appeals. • Navigate insurance payer phone trees and obtain valid information. • Generates revenue by making payment arrangements; collecting accounts; monitoring and pursuing delinquent accounts. • Presents ideas and collaborates with billing team about billing practices and methods to increase revenue.

• Provides billing support for the Sandstone Care billing team. Responsible for inputting data into multiple systems related to client information, insurance information, attendance and coding for services rendered. • Coordinates with billing team to immediately resolve billing inconsistencies and delinquent data. • Responsible for verification of benefits, billing data, claims submission, claim corrections, claim re-submissions, claim follow up and appeals. • Navigate insurance payer phone trees and obtain valid information. • Generates revenue by making payment arrangements; collecting accounts; monitoring and pursuing delinquent accounts. • Presents ideas and collaborates with billing team about billing practices and methods to increase revenue.

• Reviews and accurately interprets medical record documentation • Codes moderately complex patient classes • Assures quality and timely coding, charging and abstraction of accounts • Maintains and enhances current levels of coding knowledge • Contacts physicians to obtain information for accurate code assignments