Coding and Cost Analyst I – Medical Claims Coding, Edit Review
Geisinger
full-time
Posted on:
Location Type: Remote
Location: Pennsylvania • United States
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About the role
- Contributes to the achievement of the strategic and financial goals of the organization by conducting thorough reviews of billed services, authorizations, plan benefit documents, itemized statements, medical records, discharge summaries and detailed data reports
- Makes reimbursement or recovery recommendations based on appropriate coding, billed statistics, policies, industry standards and compliance with contractual, state, and federal regulations
- Supports and serves as a resource to other Health Plan departments by providing review and recommendation for correct coding, appropriate billing, and reimbursement
- Completes clinical reviews related to Claims, Claim Edits, Appeals and the Grievance process
- Recommends recovery efforts based on current contracts, policies, procedures and accepted industry standards
- Reviews and validates pended and reconsidered claims when edits are applied by the Plan claim editing software from multiple vendors
- Completes reviews on inpatient and outpatient high dollar claims following internal guidelines
- Assists in reviews of quality concerns
- Validates claim payments based on Plan contracts, often working with the Pharmacy team and the PNM department
- Creates and maintains various reports to track department data
- Assists in group discussions on challenging medical reviews
- Assists with onboarding new team members as needed
- Participates on selected workgroups and committees on an ad hoc basis as requested
Requirements
- Minimum ONE Certification required: CPC- Certified Professional Coder through AAPC CCS- Certified Coding Specialist through AHIMA LPN preferred
- Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience)
- Minimum of 3 years-Relevant experience* (Required)
- Minimum of 2 years-Clinical (Preferred)
Benefits
- healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners
- atmosphere of collaboration, cooperation and collegiality
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
codingbillingreimbursementclinical reviewsclaims processingdata analysisreport creationclaim editingquality reviewmedical record review
Soft Skills
communicationteam collaborationproblem-solvingattention to detailorganizational skillsresourcefulnessleadershiptrainingadaptabilitycritical thinking
Certifications
CPC - Certified Professional CoderCCS - Certified Coding SpecialistLPN - Licensed Practical Nurse