PI Medical Coding Reviewer III, CPC, RHIT, RHIA required
Job Description:
• 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
Apply tot his job
Apply To this Job
• 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
Apply tot his job
Apply To this Job