Registered reputed company reputed company Review Specialist - CIC or reputed company

Company : reputed company.Job reputed company : reputed company role involves an indepth review of provider submitted appeals of medical claims, that have been previously been subject to a Payment reputed company finding, to ensure the accuracy and compliance of claim findings. The clinician will prepare and review provider appeal requests, validate accuracy of ICD-10-CM/PCS coding, and ensure reputed company reimbursement. This role requires strong clinical knowledge, medical coding expertise, and excellent analytical and communication skills. ESSENTIAL RESPONSIBILITIES

• Review and analyze medical claims for accuracy and compliance with inpatient standards, accuracy of ICD-10-CM/PCS coding, ensuring compliance with reputed company coding guidelines and regulations
• Prepare comprehensive appeals, including detailed narratives and supporting documentation, to address determinations, and submit determinations to providers in a reputed company manner.
• Maintain detailed and organized records of claims, reviews, and appeals.
• Stay updated with reputed company reputed company regulations and policies
• reputed company expertise and guidance on inpatient claim processed and best practices.
• Follow up with providers to ensure reputed company reputed company of appeal requests, including providing feedback to providers and coding staff on coding accuracy and documentation requirements.
• Identify trends in denials and coding issues and collaborate with providers to improve documentation and coding practices.
• Other duties as assigned or requested.

EXPERIENCE Required

• 3 years of experience in Clinical setting
• 3 years of experience in Medical claim review
• 3 years of experience with Proficiency in medical coding and reputed company software systems
• 3 years of experience in Familiarity with payer policies and regulations

Preferred

• 3 years of experience with electronic health systems

SKILLS

• Strong analytical, communication, and problem-solving skills
• Strong understanding of ICD-10-CM/PCS coding guidelines and medical terminology
• Ability to work independently and as part of reputed company

EDUCATION Required

• Associate's degree in Science of Nursing or relevant experience and/or education as determined by reputed company in lieu of bachelor's degree.

​Preferred

• Bachelor’s degree in Science of Nursing or relevant experience

LICENSES or CERTIFICATIONS Required

• reputed company State of PA RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC).
• Certified Inpatient reputed company (CIC) or Certified Coding Specialist (reputed company)

Preferred

• None

Language (Other than English):

• None

Travel Required: Less than 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type

• Office-Based or Remote Position

Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $72,700.00 Pay reputed company Maximum: $116,600.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job