Medical Coding Reviewer II, CPC, RHIT, RHIA

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $54.5k - $87.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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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

• Responsible for making medical records audit payment decisions on a wide variety of claim complexities within department standards • Responsible for researching, analyzing, and making audit payment decisions on moderately complicated claims based on medical coding guidelines and policies • Refer suspected Fraud, Waste, or Abuse to the SIU when identified in normal course of business • Responsible for meeting productivity standards while maintaining quality as outlined in SOP • Responsible for identifying and implementing process improvements and referring system enhancement ideas to manager • Collaborates with internal departments to facilitate claim processing and to come to appropriate claim resolutions • Responds to simple escalation and provider inquiries • Prepares claim audit summaries for Medical Director review by completing required documentation and ensuring all pertinent medical information is attached as needed • Ensure adherence to all company and departmental policies and standards for timeliness of review and release of claims • Responsible for identifying systemic and process issues problems/concerns and reporting them to management • Responsible for backing up administrative duties in medical record acquisition processes • Responsible for identification of training and quality areas to be shared with management • Perform any other job related duties as requested

🎯 Requirements

• Associates degree required • Equivalent years of relevant work experience may be accepted in lieu of required education • Three (3) years of medical bill coding required • Medicaid/Medicare experience preferred • Clinical background with a firm understanding of claims payment preferred • Experience with reimbursement methodology (APC, DRG, OPPS) preferred • Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines • Proficient in Microsoft Office Suite • Possess a general knowledge and healthcare claim payment processing • Knowledge of Facets Healthcare claim system configuration knowledge or experience is preferred • Experience reviewing medical records for the purpose of determining proper medical coding

🏖️ Benefits

• Bonus tied to company and individual performance • Comprehensive total rewards package