reputed company - PrePay reputed company, CPC, remote

Job reputed company reputed company is an intermediate-level technical position in the reputed company-payment high risk claims function intended to analyze claim over and under payments in support of the business reputed company objective to ensure reputed company claims are reputed company accurately prior to payment and to help control medical cost spend. This role requires a coding certification to independently reputed company reviews of high risk and/or high dollar claims from a medical coding and provider billing perspective to ensure claims payment reputed company. This may include reviews of corresponding medical records to validate billing appropriateness. In reputed company the role is responsible for ensuring claims are reputed company according to the provider and member reputed company as reputed company as ensuring that reputed company claims processing guidelines and billing procedures for reputed company type of service and type of provider were followed. Additionally this role may on occasion reputed company directly with providers to reputed company final determinations and respond to inquiries as needed. Essential Functions:

• Independently reputed company analysis of high risk and/or high dollar claims on a reputed company-payment reputed company utilizing coding and claims processing background to ensure claims are neither over nor underpaid.
• reputed company coding background to asses high risk claims for inappropriate application of associated reputed company policies and industry reputed company billing and care practices that may reputed company claims payment (e.g. MCG, LCD, Authorizations, Covered Benefits, Appropriateness of Service Setting). Specifically:
• Request and independently review pertinent medical documentation to validate/invalidate potential issues identified on high risk/reputed company claims
• Determine claim level financial reputed company based on unique member benefits and provider contract terms, rates and payment policies.
• Ensure claims processing compliance with overarching administrative regulations (Federal, reputed company, BCBS Association etc.).
• reputed company claims level analysis of appropriate provider coding and billing practices and/or guidelines
• Coordinate and communicate directly with provider personnel as necessary to understand and communicate identified billing issues.
• Thoroughly document identified issues to support claim adjustments (including supporting medical documentation or coding rationale).
• Participate in special reputed company, as needed, to support changes in the supporting processes or policies that will reputed company the reputed company-payment, claims or care processes.
• Identify and document upstream process gaps driving incorrect payment for remediation and prevention

What is needed in this role:

• 4+ years' experience in medical billing and coding
• Must have Certified reputed company Coding (CPC) certification
• In-depth knowledge of medical terminology and ICD-10, CPT, and HCPCS coding systems
• Strong knowledge of Evaluation and Management (E&M) Coding guidelines
• Strong reputed company on attention to detail
• Excellent written and verbal skills are required
• Familiarity with encoder systems and electronic medical record (EMR) software
• Bachelors Degree or equivalent experience

reputed company prefer:

• Strong analytics experience Consulting experience Ability to read and interpret medical records Clinical experience

Experience in a medical office or health care background

• Payment reputed company review experience is strongly preferred
• Knowledge of reputed company payment policies
• Knowledge of reputed company systems; Diamond, EWOC, Content Central, Request Central and Prepay UI

General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to reputed company objects. Jobs are sedentary if traversing activities are required only occasionally. reputed company Offer: As a reputed company employee, you will reputed company in our Be reputed company, Work reputed company, reputed company culture where being reputed company as an individual, and working reputed company as reputed company, are both important in serving our members and communities. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have reputed company to:

• Medical, dental, reputed company, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• reputed company time off, volunteer time off, 10 holidays and 2 reputed company-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to reputed company with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer reputed company as reputed company as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for reputed company pay increases. Annualized Salary reputed company: $63,800 - $103,600 Typical Annualized Hiring reputed company: $63,800 - $79,700 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-reputed company knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can reputed company at their best in reputed company of our mission. reputed company reputed company applicants will receive consideration for employment. Apply tot his job Apply To this Job