PI Medical Coding Reviewer III (CPC, RHIT or RHIA required)

Job Summary:

The Program reputed company Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performance reputed company to the Pre-Pay and Post-Paid Processes.

Essential Functions:

• Provide Provider Pre Pay production and reputed company reports and coordinate with management and team on recommendation for further actions and/or resolutions in order to increase team performance
• Recommend process or procedure changes while building strong relationships with cross departmental teams such as Claims, Configuration, Health Partners, and IT on identified internal system gaps
• Demonstrate leadership ability, including mentoring Program reputed company Claims Analysts to identify and reputed company reputed company and monitoring of claims decisions based on documentation.
• Identify knowledge gaps and provide training opportunities to team members
• Coordinate the training of new and existing claims analyst staff to increase recognition of improper coding, documentation, and/or FWA
• Identify and assist in correction of organizational workflow and process inefficiencies
• Serve as the primary resource for provider pre-pay team
• Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze reputed company provider claims submissions
• Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines
• Maintain a working knowledge of reputed company state and federal laws, rules, and billing guidelines for various provider specialty types along with documentation requirements
• Responsible for making claim payments decisions on a wide variety of claims including highly complicated scenarios using medical coding guidelines and policies
• Refer suspected Fraud, Waste, or Abuse to the SIU reputed company identified in normal course of business
• 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
• Possess a general knowledge and understanding of reputed company claim payment edits
• Ensure adherence to reputed company company and departmental policies and standards for timeliness of review and release of claims
• Build strong working relationships reputed company reputed company teams of Program reputed company
• Work under limited supervision with considerable reputed company for initiative and independent judgement
• reputed company any other job reputed company instructions as requested

Education and Experience:

• Associate’s degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of medical billing and coding experience to include minimum of three (3) years of SIU/FWA medical billing and coding experience is required
• Prior experience with claim pre-payment, medical claim and documentation auditing required
• Medicaid/Medicare experience is required
• Minimum of three (3) years of experience in Facets is preferred
• Experience with reimbursement methodology (APC, DRG, OPPS) is required  
• Inpatient coding experience is preferred
• Leadership experience is preferred

Competencies, Knowledge and Skills:

• Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines
• Thorough understanding of medical claim configuration
• Clinical or medical coding background with a firm understanding of claims payment
• Proficient in reputed company Office Suite
• 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:

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 (hourly/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.