PI Medical Coding Reviewer III, CPC, RHIT, RHIA

Job not on LinkedIn

🕒 6 days ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs • Provide Provider Pre Pay production and progress reports • Recommend process or procedure changes while building strong relationships with cross departmental teams • Demonstrate leadership ability, including mentoring Program Integrity Audit Analysts • Identify knowledge gaps and provide training opportunities to team members • Coordinate the training of new and existing claims analyst staff • Identify and assist in correction of organizational workflow and process inefficiencies • Serve as a primary resource for provider escalation support • Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze complex provider claims submissions • Maintain a working knowledge of all state and federal laws, rules, and billing guidelines

🎯 Requirements

• Associates degree required • Equivalent years of relevant work experience may be accepted in lieu of required education • Five (5) years of medical billing and coding experience to include minimum of three (3) years of SIU/FWA medical billing and coding experience required • Prior experience with claim pre-payment, medical claim and documentation auditing required • Medicaid/Medicare experience required • Three (3) years of experience in Facets preferred • Experience with reimbursement methodology (APC, DRG, OPPS) required • Inpatient coding experience preferred • Leadership experience preferred

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities • Bonuses