Claims Auditor, Reviewer, Coder
Job Description:
- provide expertise in quality assurance, claims processing, medical coding, and audit activities
- support quality assurance and audit planning
- conduct claims reviews and audits
- analyze claims data to identify trends and issues
- research federal payer coverage policies
- develop and improve program policies and procedures
- maintain the health plan codebook
- ensure accurate application of medical coding standards
- recommend improvements to processes and benefit plans based on industry best practices
- interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts
Requirements:
- A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA)
- A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting
- Experience in healthcare quality, medical coding, and claims auditing
- Demonstrated expertise in CPT, HCPC and ICD billing codes
- Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint
- Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable
Benefits:
- paid leave
- options for employer sponsored group medical
- dental
- vision
- short-term and long-term disability
- life insurance
- AD&D coverage
- legal services
- identity theft
- accident insurance
- flexible spending account
- health saving account options
- 401(k) retirement plan with employer contribution match
- professional growth through professional courses
- certifications
- tuition reimbursement programs