Program Integrity Medical Coding Reviewer III, CPC, RHIT, RHIA
CareSource
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $62,700 - $100,400 per year
About the role
- Generate comprehensive and concise in-depth reporting and analysis for Pre-Pay and Post-Paid Processes
- Provide Provider Pre Pay production and progress reports and coordinate with management and team
- Recommend process or procedure changes and build strong relationships with cross departmental teams
- Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts
- Identify knowledge gaps and provide training opportunities
- Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws
- Responsible for making claim payments decisions on a variety of claims
- Respond to claim questions and concerns and prepare claims for Medical Director review
Requirements
- Associate’s degree or equivalent years of relevant work experience
- Minimum of five (5) years of medical billing and coding experience
- Minimum of three (3) years of SIU/FWA medical billing and coding experience
- Prior experience with claim pre-payment, medical claim and documentation auditing
- Medicaid/Medicare experience
- Minimum of three (3) years of experience in Facets preferred
- Experience with reimbursement methodology (APC, DRG, OPPS)
- Inpatient coding experience preferred
- Leadership experience preferred
- Knowledge of diagnosis codes and CPT coding guidelines
- Proficient in Microsoft Office Suite
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingcodingclaim pre-paymentdocumentation auditingreimbursement methodologydiagnosis codesCPT coding guidelinesinpatient codingSIU/FWA experienceMedicaid/Medicare experience
Soft Skills
leadershipmentoringrelationship buildingtrainingcommunication
Certifications
Associate’s degree