Medical Coding Auditor job at Insight Global in Mayfield Heights, OH
Title: Remote Medical Coding Auditor
Location Mayfield Heights, Ohio
ZIP/Postal Code 44124
Job Type Contract
Category Medical Coder
Req #MSP-72131095-bff8-4699-a315-78b7ffb7be73
Pay Rate $32 - $40 (hourly estimate)
Job Description:
The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
Essential Functions
Provide Provider Pre Pay production and progress reports and coordinate with management
and team on recommendation for further actions and/or resolutions in order to increase team
performance
Recommend process or procedure changes while building strong relationships with cross
departmental teams such as Claims, Configuration, Health Partners, and IT on identified
internal system gaps
Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts to
identify and perform oversight and monitoring of claims decisions based on documentation
Identify and assist in correction of organizational workflow and process inefficiencies
Serve as the primary resource for provider pre-pay team
Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze
complex provider claims submissions
Research, comprehend and interpret various state specific Medicaid, federal Medicare, and
ACA/Exchange laws, rules and guidelines
Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for
various provider specialty types along with documentation requirements
Responsible for making claim payments decisions on a wide variety of claims including highly
complicated scenarios using medical coding guidelines and policies
Refer suspected Fraud, Waste, or Abuse to the SIU when identified in normal course of
business
Responds to claim questions and concerns
Prepares claims 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
Build strong working relationships within all teams of Program Integrity
Work under limited supervision with considerable latitude for initiative and independent
judgement
Performs any other job related duties as requested.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
Education and Experience
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
Experience with reimbursement methodology (APC, DRG, OPPS) required
Able to work off of a virtual desktop with your own laptop/equipment
This position must be their only role within medical coding/auditing due to potential conflict of interest
Competencies, Knowledge and Skills
Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and
physiology; and Medicaid/Medicare reimbursement guidelines
Thorough understanding of medical claim configuration
Clinical or medical coding background with a firm understanding of claims payment
Proficient in Microsoft Office Suite
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 of healthcare industry
Effective listening and critical thinking skills
Ability to develop, prioritize and accomplish goals
Strong interpersonal skills and high level of professionalism
Licensure and Certification
Certified Medical Coder (CPC, RHIT or RHIA) is required at time of hire required
Nice to Have Skills & Experience
Inpatient coding experience preferred
Three (3) years of experience in Facets preferred
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.
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Location Mayfield Heights, Ohio
ZIP/Postal Code 44124
Job Type Contract
Category Medical Coder
Req #MSP-72131095-bff8-4699-a315-78b7ffb7be73
Pay Rate $32 - $40 (hourly estimate)
Job Description:
The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
Essential Functions
Provide Provider Pre Pay production and progress reports and coordinate with management
and team on recommendation for further actions and/or resolutions in order to increase team
performance
Recommend process or procedure changes while building strong relationships with cross
departmental teams such as Claims, Configuration, Health Partners, and IT on identified
internal system gaps
Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts to
identify and perform oversight and monitoring of claims decisions based on documentation
Identify and assist in correction of organizational workflow and process inefficiencies
Serve as the primary resource for provider pre-pay team
Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze
complex provider claims submissions
Research, comprehend and interpret various state specific Medicaid, federal Medicare, and
ACA/Exchange laws, rules and guidelines
Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for
various provider specialty types along with documentation requirements
Responsible for making claim payments decisions on a wide variety of claims including highly
complicated scenarios using medical coding guidelines and policies
Refer suspected Fraud, Waste, or Abuse to the SIU when identified in normal course of
business
Responds to claim questions and concerns
Prepares claims 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
Build strong working relationships within all teams of Program Integrity
Work under limited supervision with considerable latitude for initiative and independent
judgement
Performs any other job related duties as requested.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
Education and Experience
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
Experience with reimbursement methodology (APC, DRG, OPPS) required
Able to work off of a virtual desktop with your own laptop/equipment
This position must be their only role within medical coding/auditing due to potential conflict of interest
Competencies, Knowledge and Skills
Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and
physiology; and Medicaid/Medicare reimbursement guidelines
Thorough understanding of medical claim configuration
Clinical or medical coding background with a firm understanding of claims payment
Proficient in Microsoft Office Suite
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 of healthcare industry
Effective listening and critical thinking skills
Ability to develop, prioritize and accomplish goals
Strong interpersonal skills and high level of professionalism
Licensure and Certification
Certified Medical Coder (CPC, RHIT or RHIA) is required at time of hire required
Nice to Have Skills & Experience
Inpatient coding experience preferred
Three (3) years of experience in Facets preferred
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.
Apply tot his job
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