PI Medical Coding Reviewer II, CPC, RHIT, RHIA

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $54.5k - $87.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

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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

• Review medical record audit activities, dispute support, medical records work queues, and provider pre-payment and post-payment claim reviews • Make medical records audit payment decisions on claims of varying complexity within department standards • Research, analyze, and make audit payment decisions on moderately complicated claims using medical coding guidelines and policies • Refer suspected Fraud, Waste, or Abuse to the SIU when identified • Meet productivity standards while maintaining quality according to SOP • Identify and implement process improvements and refer system enhancement ideas to the manager • Collaborate with internal departments to facilitate claim processing and reach appropriate claim resolutions • Respond to simple escalations and provider inquiries • Prepare claim audit summaries for Medical Director review with required documentation and pertinent medical information • Ensure adherence to company and departmental policies and timeliness standards for claim review and release • Identify systemic and process issues and report them to management • Back up administrative duties in medical record acquisition processes • Identify training and quality areas to share with management • Perform other job-related duties as requested

🎯 Requirements

• Associates degree required, or equivalent years of relevant work experience may be accepted in lieu of required education • Three (3) years of medical bill coding required • Certified Medical Coder (CPC, RHIT or RHIA) required at time of hire • 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 • Knowledge of medical terminology, anatomy and physiology, and Medicaid/Medicare reimbursement guidelines • Proficient in Microsoft Office Suite • General knowledge of healthcare claim payment processing • Knowledge of Facets • Healthcare claim system configuration knowledge or experience preferred • Experience reviewing medical records to determine proper medical coding • Firm understanding of basic medical billing process • Excellent written and verbal communication skills • Ability to work independently and within a team environment • Effective problem-solving skills with attention to detail • Knowledge of Medicaid/Medicare and familiarity with healthcare industry • Effective listening and critical thinking skills • Ability to develop, prioritize, and accomplish goals • Strong interpersonal skills and high level of professionalism

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee total well-being support

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