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Claims Auditor, Reviewer, Coder
Planned Systems InternationalClaims Auditor, Reviewer and Coder providing expertise in quality assurance and medical coding for the WTC Health Program. Supporting audit activities and claims processing for a federal health care program.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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
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
Claims AuditingData AnalysisMedical Coding StandardsProgram Policy DevelopmentClaims Review
Soft Skills
CollaborationCommunication
Certifications
Registered Health Information Administrator (RHIA)Registered Health Information Technician (RHIT)Certified Coding Specialist (CCS)