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Program Integrity Medical Coding Reviewer III, CPC, RHIT, RHIA

Medical Billing and CodingMedical Billing and CodingOtherRemoteSeniorTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

131 days ago

Salary

$62.7K - $100.4K / year

Seniority

Senior

Associate Degree5 yrs expEnglish

Job Description

Program Integrity Medical Coding Reviewer III, CPC, RHIT, RHIA

CareSource

• Generate comprehensive and concise in-depth reporting and analysis for Pre-Pay and Post-Paid Processes • Provide Provider Pre Pay production and progress reports and coordinate with management and team • Recommend process or procedure changes and build strong relationships with cross departmental teams • Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts • Identify knowledge gaps and provide training opportunities • Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws • Responsible for making claim payments decisions on a variety of claims • Respond to claim questions and concerns and prepare claims for Medical Director review

Job Requirements

  • Associate’s degree or equivalent years of relevant work experience
  • Minimum of five (5) years of medical billing and coding experience
  • Minimum of three (3) years of SIU/FWA medical billing and coding experience
  • Prior experience with claim pre-payment, medical claim and documentation auditing
  • Medicaid/Medicare experience
  • Minimum of three (3) years of experience in Facets preferred
  • Experience with reimbursement methodology (APC, DRG, OPPS)
  • Inpatient coding experience preferred
  • Leadership experience preferred
  • Knowledge of diagnosis codes and CPT coding guidelines
  • Proficient in Microsoft Office Suite

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development
  • Bonuses

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