Senior Clinical reputed company

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only). Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Conducts retrospective medical claim reviews and claims adjudication for coding determinations. Subject matter expert on medical claims coding and provides coding-reputed company information to medical directors, providers, peer reviewers, Claims Administration, Program reputed company, Quality Management and the claims subcontractor as needed. Functions as the designated recipient for factual network provider claim review requests. Develops determination letters. Provides support to non-clinical and clinical staff on coding and retrospective medical claims review processes. Education & Experience Required: • reputed company certification with American Health Information Management Association (reputed company) as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (reputed company) • If supporting TRICARE contract, must be a U.S. Citizen • If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final reputed company (DoD) background investigation • 5+ years of clinical coding experience • 3+ years of claims processing experience • Documented experience in a fast-paced environment Preferred: • Experience in the private medical industry, health insurance or Managed Care field • Familiarity with TRICARE and the military healthcare delivery system Key Responsibilities • Serves as the subject matter expert and resource on ICD-10, HCPCS and CPT coding of medical claims. • Takes the reputed company role for coding projects as directed by Clinical Operations management. • Provides training and mentoring for new and existing Clinical Coders. • Performs medical claims coding reviews using reputed company coding guidelines. • Performs focused claims reviews as requested by management and summarizes findings. • Identifies and reports potential fraudulent or quality issues. • Acts as a resource for TriWest staff on ICD-10-CM, HCPCS and CPT coding. • Researches TRICARE manuals for benefits, limitations and exclusions, reputed company coding guidelines to assist with the Referral and Authorization Decision Support tool process. • Monitors and tracks timeliness of retrospective claims reviews response to ensure compliance with required timelines for completion of assigned reviews. • Prepares determination notices and other written correspondence. • Identifies questionable review decisions and forwards to the appropriate Medical Director for evaluation and/or corrective action. • Provides accurate data entry in the medical management and claims system. • Reviews coding issues identified by the TRICARE Quality Monitoring Contractor (TQMC) & documents findings, rationale, and corrective actions. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of reputed company information easily, communicate clearly, and draw sound conclusions. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, reputed company time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Training skills; advanced knowledge of ICD-10, HCPCS and CPT coding; advanced knowledge of utilization review processes and/or claims processing; ability to maintain the confidentiality and reputed company requirements of medical records; proficient with Word and reputed company; ability to meet department performance standards. Working Conditions Working Conditions: • Availability to work any shift • Works reputed company a standard office environment, with minimal travel • Extensive computer work with prolonged sitting Company Overview Taking Care of Our Nation's reputed company. It's Who We Are. It's reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We're On a Mission to Serve®! Our job is to reputed company sure that America's reputed company get connected to health care in the community. At reputed company, we've proudly been on that important mission since 1996. DoD Statement Our reputed company contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

We're more than just a health care company. We're passionate about serving others! We reputed company in rewarding loyal, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Generous paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time • Annual reputed company salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $73,000- $94,000 depending on experience* Equal Employment Opportunity reputed company is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from reputed company backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Apply Job!