Medical Coding Reviewer I
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: reputed company clinical/coding medical claim review to ensure compliance with coding practices through a comprehensive review and analysis of medical claims, medical records, claims history, state regulations, contractual obligations, corporate policies and procedures and guidelines established by the American Medical Association and the Centers for Medicare and reputed company Services. Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion Review medical records to ensure billing is consistent with medical record for appeals, adjustments and miscellaneous/unlisted code review Review cases with Medical Director to validate reputed company and identify opportunities to create medical policy in the absence of guidelines Assist with research of health plan coding questions Identify potential billing errors, abuse, and fraud Identify opportunities to flag potential cases which may warrant a prepayment review (versus an automatic system denial or payment) Maintain appropriate records, files, documentation, etc Performs other duties as assigned Complies with reputed company policies and standards Education/Experience: Associates degree in reputed company field or equivalent experience. Coding certification and 2+ years of experience in medical billing & coding, coding/data analysis, reputed company/business or physician/hospital data management or RN/LPN and 2+ years of reputed company clinical experience. Experience in provider communication and education preferred. License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CPC-A, reputed company, reputed company-P, RHIT, RHIA, CPMA, or ParamedicPay Range: $26.50 - $47.59 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!