PI Medical Coding Reviewer III, CPC, RHIT, RHIA required

Job Description: • Generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes • Provides Provider Pre Pay production and progress reports and coordinates with management and team on recommendation for further actions and/or resolutions • Recommends process or procedure changes while building strong relationships with cross departmental teams • Demonstrates leadership ability, including mentoring Program Integrity Claims Analysts • Identifies knowledge gaps and provides training opportunities to team members • Coordinates the training of new and existing claims analyst staff • Identifies and assists in correction of organizational workflow and process inefficiencies • Serves as the primary resource for provider pre-pay team • Analyzes complex provider claims submissions using medical coding guidelines and policies • Researches, comprehends and interprets various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Requirements: • Associate’s degree or equivalent years of relevant work experience is required • Minimum of five (5) years of medical billing and coding experience • Minimum of three (3) years of SIU/FWA medical billing and coding experience • Prior experience with claim pre-payment, medical claim and documentation auditing required • Medicaid/Medicare experience is required • Minimum of three (3) years of experience in Facets is preferred • Experience with reimbursement methodology (APC, DRG, OPPS) is required • Inpatient coding experience is preferred • Leadership experience is preferred • Knowledge of diagnosis codes and CPT coding guidelines; medical terminology; anatomy and physiology; and Medicaid/Medicare reimbursement guidelines. Benefits: • Comprehensive total rewards package • Health insurance • Retirement plans • Professional development opportunities