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About the role
Key responsibilities & impact- Support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs.
- Evaluate quality of care, reviewing medical records and program policies and identifying compliance issues.
- Prepare audit documentation and reports, and support appeals activities.
- Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer.
- Identify potential documentation deficiencies, and billing compliance issues.
- Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
- Assist with audit responses and appeals as needed.
- Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines.
Requirements
What you’ll need- RN license preferred; Indiana license or compact license accepted.
- Coding certification such as CCS or CPC strongly preferred.
- At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience.
- Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred.
- Knowledge of CPT coding guidelines and ICD-10 standards.
- Proficiency in Microsoft Excel, Word, and Outlook.
- Strong analytical, critical thinking, problem-solving, and technical writing skills.
- Ability to work independently and collaboratively in a fast-paced environment.
- Experience working with healthcare providers strongly preferred.
- Knowledge of healthcare claims data and fraud, waste, and abuse preferred.
Benefits
Comp & perks- Solutions come from creative ideas; ideas come from being creative with differences.
- Briljent believes diversity and inclusion are critical to the success of the company.
- We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
billing complianceMedicaid claims reviewCPT codingICD-10 standardsaudit documentationmedical record reviewhealthcare reimbursementdocumentation requirementscoding certification
Soft Skills
analytical skillscritical thinkingproblem-solvingtechnical writingindependent workcollaborative workfast-paced environment
Certifications
RN licenseCCS certificationCPC certification