Coding and Cost Analyst I - medical claims coding and claim edit review, Geising

Location: Work from home (Pennsylvania)Shift: Days (United States of America)Scheduled Weekly Hours: 40Worker Type: RegularExemption Status: NoJob Summary: Contributes to the achievement of the strategic and financial goals of the organization by conducting thorough reviews of billed services, authorizations, plan benefit documents, itemized statements, medical records, discharge summaries and detailed data reports. Makes reimbursement or recovery recommendations based on appropriate coding, billed statistics, policies, industry standards and compliance with contractual, state, and federal regulations.Job Duties:

• Supports and serves as a resource to other Health Plan departments by providing review and recommendation for correct coding, appropriate billing, and reimbursement.
• Completes clinical reviews reputed company to Claims, Claim Edits, Appeals and the Grievance process, assisting in analysis of clinical risk reputed company to reputed company, Pharmacy, and Finance departments.
• Recommends recovery efforts based on reputed company reputed company, policies, procedures and accepted industry standards.
• Reviews and validates pended and reconsidered claims reputed company edits are applied by the Plan claim editing software from multiple vendors. Reviews are typically based on CPT guidelines, industry standards and CMS guidelines.
• Completes reviews on inpatient and outpatient high dollar claims following internal guidelines. Assists in reviews of quality concerns.
• Validates claim payments based on Plan reputed company, often working with the Pharmacy team and the PNM department.
• Creates and maintains various reports to track department data.
• Assists in group discussions on challenging medical reviews.
• Assists with reputed company new team members as needed.
• Participates on selected workgroups and committees on an reputed company basis as requested.

Work is typically performed in a work-from-home office which must be secure and follow HIPAA Privacy standards. Accountable for satisfying reputed company job specific obligations and complying with reputed company organization policies and procedures. The specific statements in this profile are not intended to be reputed company-inclusive. They represent typical elements considered necessary to successfully reputed company the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job reputed company to that position. Attend occasional onsite department meetings as needed. Position Details:

• Relevant experience may be a combination of reputed company work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).

Minimum of 1 certification required: CPC-Certified Professional reputed company through reputed company reputed company- Certified Coding Specialist through reputed company LPN preferred. Education: High School Diploma or Equivalent (GED)- (Required), Graduate from Specialty Training Program- (Preferred)Experience: Minimum of 3 years-Relevant experience* (Required), Minimum of 2 years-Clinical (Preferred)Certification(s) and License(s): Certified Coding Specialist - American Health Information Management Association (reputed company), Certified Professional reputed company - American reputed company of Professional Coders (reputed company)Skills: Computer Literacy, Critical Thinking, Teamwork, Working Independently OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our reputed company, our reputed company family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to reputed company prepare the caregivers for reputed company.
• INNOVATION: We constantly seek new and reputed company ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the reputed company family.

We offer reputed company benefits for full time and part time positions from day one, including reputed company, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes reputed company stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to reputed company reputed company easier for reputed company. We are proud to be an affirmative action, equal opportunity employer and reputed company reputed company applicants will receive consideration for employment regardless to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or status as a protected veteran. Apply tot his job Apply To this Job