PI Medical Coding Reviewer III, CPC, RHIT, RHIA required
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
- Generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes
- Provides Provider Pre Pay production and progress reports and coordinates with management and team on recommendation for further actions and/or resolutions
- Recommends process or procedure changes while building strong relationships with cross departmental teams
- Demonstrates leadership ability, including mentoring Program Integrity Claims Analysts
- Identifies knowledge gaps and provides training opportunities to team members
- Coordinates the training of new and existing claims analyst staff
- Identifies and assists in correction of organizational workflow and process inefficiencies
- Serves as the primary resource for provider pre-pay team
- Analyzes complex provider claims submissions using medical coding guidelines and policies
- Researches, comprehends and interprets various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines
Requirements
- Associate’s degree or equivalent years of relevant work experience is required
- 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 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
- Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines.
Benefits
- Comprehensive total rewards package
- Health insurance
- Retirement plans
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingmedical codingclaims auditingreimbursement methodologydiagnosis codesCPT codinginpatient codingMedicaid guidelinesMedicare guidelinesACA/Exchange laws
Soft Skills
leadershipmentoringrelationship buildingtraininganalytical skillscommunicationproblem-solvingcollaborationorganizational skillsprocess improvement
Certifications
Associate’s degree