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Program Integrity Medical Coding Reviewer II, CPC, RHIT, RHIA
Location
United States
Posted
129 days ago
Salary
$54.5K - $87.3K / year
Seniority
Senior
Job Description
Program Integrity Medical Coding Reviewer II, CPC, RHIT, RHIA
CareSource
• Responsible for making claim payments decisions on a wide variety of claims within department standards • Responsible for researching, analyzing, and making payment decisions on moderately complicated claims based on medical coding guidelines and policies • Refer suspected Fraud, Waste, or Abuse to the SIU when identified in normal course of business • Acts as a technical resource to new associates by reviewing claims, training staff, responding to claim questions • Responsible for identifying and implementing process improvements and referring system enhancement ideas to manager • Collaborates with internal departments to facilitate claim processing and to come to appropriate claim resolutions • Responds to claim questions and concerns • Prepares claims for Medical Director review by completing required documentation and ensuring all pertinent medical information is attached as needed • Ensure adherence to all company and departmental policies and standards for timeliness of review and release of claims • Responsible for identifying systemic claim problems/concerns and reporting them to management • Responsible for supporting provider pre-pay and post-pay teams with coding reviews and clinical documentation reviews • Provide support for provider appeals to denied claims
Job Requirements
- Associate’s degree or equivalent years of relevant work experience is required
- Minimum of three (3) years of medical bill coding is required
- Medicaid/Medicare experience is preferred
- Clinical background with a firm understanding of claims payment is preferred
- Experience with reimbursement methodology (APC, DRG, OPPS) is preferred
- Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines
- Proficient in Microsoft Office Suite
- Possess a general knowledge and healthcare claim payment processing
- Knowledge of Facets Healthcare claim system configuration knowledge or experience is preferred
- Experience reviewing medical records for the purpose of determining proper medical coding
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
- Bonuses
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