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Western Growers logo
Western Growers

We represent family farmers growing fresh produce in Arizona, California, Colorado and New Mexico.

Coder

Medical Billing and CodingMedical Billing and CodingFull TimeRemoteMid LevelTeam 201-500Since 1926H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

91 days ago

Salary

$44.7K - $65.7K / year

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Coder

Western Growers

• plan code new business and plan changes • verify new and existing plans loaded on the company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments • respond to work orders received from examiners to investigate plan issues and irregularities • evaluate testing requests for all new plans prior to loading them into the production system • keep a detailed log of open and completed work • document resolutions to closed work orders • identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses • create and document a minimum of one new Standard Operating Procedure (SOP) annually • identify, initiate and implement at least one process improvement and/or innovation annually • maintain detailed log of plans that are currently being coded and in the process of being loaded • send confirmations to internal stakeholders when applicable plans have been loaded • work with programmers to test claims and related system programs to verify impact within the Health Care Processing System (HCPS) • utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members

Job Requirements

  • BS/BA degree in computer science, business or related field
  • minimum of two years of experience as a pharmacy, medical, dental claims auditor and/or plan testing experience, preferred
  • exceptional ability to interpret summary plan descriptions of employee medical, dental, pharmacy benefits
  • strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demanding environment to meet expected goals, dates, and milestones
  • excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials
  • superior ability to analyze and interpret group health benefits provisions, administrative policies, and provider contracts
  • advanced skills in Microsoft Office applications, specifically word processing and spreadsheets
  • demonstrated ability to analyze and comprehend complex issues, and personalities using independent judgment, leadership, tact, diplomacy, and initiative

Benefits

  • affordable health benefit solutions
  • flexible work arrangements
  • competitive compensation packages
  • profit-sharing

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