Claims Auditor, Reviewer, Coder

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Planned Systems International

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1988

🔒 Cybersecurity

🏛️ Government

Healthcare • Cybersecurity • Government

Planned Systems International is a company focused on developing innovative solutions at the intersection of health, national security, and federal civilian operations. Since its inception in 1988, PSI has utilized cutting-edge technologies to tackle critical challenges faced by government and civilian agencies, striving to elevate healthcare accessibility through programs like the ARPA-H PARADIGM initiative. The company emphasizes operational efficiency and integrity, while fostering a collaborative work culture to empower its employees and meet diverse client needs.

📋 Description

• provide expertise in quality assurance, claims processing, medical coding, and audit activities • support quality assurance and audit planning • conduct claims reviews and audits • analyze claims data to identify trends and issues • research federal payer coverage policies • develop and improve program policies and procedures • maintain the health plan codebook • ensure accurate application of medical coding standards • recommend improvements to processes and benefit plans based on industry best practices • interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts

🎯 Requirements

• A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA) • A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting • Experience in healthcare quality, medical coding, and claims auditing • Demonstrated expertise in CPT, HCPC and ICD billing codes • Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint • Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable

🏖️ Benefits

• paid leave • options for employer sponsored group medical • dental • vision • short-term and long-term disability • life insurance • AD&D coverage • legal services • identity theft • accident insurance • flexible spending account • health saving account options • 401(k) retirement plan with employer contribution match • professional growth through professional courses • certifications • tuition reimbursement programs