Posted in Other 19 days ago.
Reviews and audits claims for billing, coding, services and other compliance or reimbursement issues. Assists with non-clinical aspects of the claims review process and benefit design/coding . Supports and educates other departments to provide an enterprise level solution for the resolution of claims and benefit design/coding. Applies coding skills to various initiatives to ensure claims payment integrity. Works under moderate supervision. Licensure: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) in ICD-10-CM coding required. Education: Bachelor's Degree or the equivalent work experience required. Experience: Minimum tthree years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems, required. Experience working with claims policy and contract implementation required. Proficient with personal computers required. Knowledge of Federal and State Medicaid guidelines, managed care programs, practices and regulations required. Demonstrated proficiency with the principles and methodologies of process improvement required.