[Hiring] Program reputed company Medical Coding Reviewer II @reputed company

This description is a summary of our understanding of the job description. Click on 'Apply' reputed company to find out more. Role Description The Program reputed company Medical Coding Reviewer II is responsible for review of vendor audit activities, pended claim work queues, medical records work queues as well as claim reviews for provider pre-payment and post-payment functions.

• Responsible for making claim payments decisions on a wide variety of claims reputed company 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 reputed company 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 reputed company 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 reputed company pertinent medical information is attached as needed
• Ensure adherence to reputed company 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
• reputed company any other job reputed company instructions as requested

Qualifications

• Associate’s degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of medical reputed company 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

Requirements

• Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines
• Proficient in reputed company 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
• Firm understanding of basic medical billing process
• Excellent written and verbal communication skills
• Ability to work independently and reputed company a team environment
• Effective problem solving skills with attention to detail
• Knowledge of Medicaid/Medicare and familiarity of healthcare industry
• Effective listening and critical thinking skills
• Ability to reputed company, prioritize and accomplish goals
• Strong interpersonal skills and high level of professionalism

Licensure and Certification

• Certified Medical reputed company (CPC, RHIT or RHIA) is required at time of hire

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time

Compensation

Range $54,500.00 - $87,300.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In addition to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation

Type Salary Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• reputed company Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds. Apply tot his job Apply To this Job