Coding Quality Analyst II, reputed company

2324785 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. This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 2 weeks of on-the-job training. The hours of the training will be reputed company with your schedule. 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 recoding
• 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 team
• Work with applicable business partners to obtain additional information relevant to the clinical review

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)
• Certified reputed company reputed company (reputed company, reputed company-P) or reputed company certified reputed company (CPC, CPC-I) or Nurse (RN, LPN) with unrestricted license
• 2+ years of experience as an reputed company or reputed company certified reputed company
• 2+ years of CPT/HCPCS/ICD – 10/CM/PCS coding experience or Licensed nurse with medical record auditing and coding/billing experience
• 1+ years of experience working in a team atmosphere in a metric driven environment including daily production standards and quality standards
• 1+ years of experience with CPT/HCPCS/Modifiers (Medical necessity, DRG, and risk adjustment coding review experience is not applicable to this position)
• 1+ years of experience working with reviewing medical records
• Intermediate level of proficiency with reputed company & reputed company applications (Outlook, Power reputed company, Word, reputed company, OneNote, Teams, PDF)
• Ability to work full-time, 8:00am – 4:30pm CST including the flexibility to work occasional overtime given the business need
• Must be 18 years of age OR older

Preferred Qualifications:

• Healthcare claims experience/processing experience
• Understanding of Waste & Error principles
• Knowledge of health insurance business, industry terminology, and regulatory guidelines
• Experience with Payment reputed company
• Analytical reputed company working with medical terminology or coding

Telecommuting Requirements:

• Ability to reputed company reputed company company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service
• 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