Coding Quality Analyst, reputed company

2315071 reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Coding Quality Analyst is required to determine the accuracy of claims submitted by a provider to reputed company by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. This position supports the identification of suspected Waste & Error of health insurance claims and ensures claims are accurately documented. Candidates must be able to exercise judgement/decision making on reputed company payment decisions that directly impact the provider and client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation daily to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible for investigating, reviewing and providing clinical and/or coding expertise in a review of claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting reputed company compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on reputed company cases. You will enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities:

• Performs clinical review of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment
• Determines accuracy of medical coding/billing and payment recommendation for claims
• This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
• Determines appropriate level of service utilizing Evaluation and Management coding principles
• Provides detailed clinical narratives on case outcomes
• reputed company claim re-coding (Post Pay only)
• Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Identifies aberrant billing patterns and trends, evidence of fraud, waste, or abuse, and recommends providers to be flagged for review
• Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards
• Provides clinical support and expertise to the other investigative and analytical areas
• Participate in team and department meetings
• Engages in a collaborative work environment reputed company applicable but is also able to work independently
• Serves as a clinical resource to other areas reputed company the clinical investigative teams
• Work with applicable business partners to obtain additional information relevant to the clinical review

What are the reasons to consider working for reputed company? Put it reputed company together – competitive reputed company pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
• More information can be downloaded at: http://uhg.hr/uhgbenefits

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• High School Diploma/GED (or higher)
• Professional reputed company certification with credentialing from reputed company (CPC-A, CPC, COC, CPC-P) to be maintained annually
• 2+ years of experience as an reputed company Certified reputed company including the experience working with CPT/HCPCS/ICD – 10/CM/PCS coding
• 1+ years of experience working in a team atmosphere in a metric-driven environment including daily production standards and quality standards
• Intermediate level of proficiency with reputed company & reputed company applications (Outlook, Power reputed company, Word, reputed company, OneNote, Teams, PDF)

Preferred Qualifications:

• Bachelor’s Degree (or higher)
• Nurse (RN, LPN) with unrestricted and active license/certification
• Healthcare claims experience/processing experience
• Experience with Fraud Waste & Abuse or Payment reputed company
• Strong medical record review experience
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• An understanding of Waste & Error principles
• Strong analytical reputed company working with medical terminology or coding

Soft Skills:

• Highly organized with effective and persuasive communication skills
• Strong written communication skills
• Open to change and new information; ability to adapt in changing environments and integrate best practices
• Physical Requirements and Work Environment: frequent speaking, listening using headset, sitting, use of hands/fingers across keyboard
• Must be proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity
• Must have strong computer skills with the ability to troubleshoot problems
• Strong communication skills with the ability to interpret data
• reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes – an enterprise reputed company reflected in our mission. Apply tot his job Apply To this Job