Coding Quality Analyst - National Remote

Key Job Details:

• Location: Remote
• Start Date: Immediate openings available
• Position: Coding Quality Analyst - National Remote
• Compensation: a competitive salary
• Company: Workwarp

 

 

You'll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel... their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Coding Quality Analyst is required to determine the accuracy of claims submitted by a provider to reputed company by comparing it to the medical record(s) submitted for the date(s) of service being reviewed. They must be able to exercise judgement/decision making on reputed company payment decisions that directly impacts the provider and UHC/Client by following state and government compliance guidelines, coding requirements and policies. They must confidently analyze and interpret data and medical records/documentation on a daily basis to understand historical claims activity, determine validity and demonstrate their ability to provide written communication to the provider. They are responsible to investigate, review and provide clinical and/or coding expertise in a review of pre-payment claims. They need to effectively manage their caseload and monthly metrics in a production driven environment and ensure they are meeting reputed company compliance turnaround times mandated by the client. The Coding Quality Analyst must be proficient in computer skills and able to navigate multiple systems at one time with varying levels of complexity. They must have the ability to research and work independently on making decisions on reputed company cases. This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours during training will be 8:00am - 5:00pm, Monday - Friday. ?reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy. Primary Responsibilities: ?Performs quality audits of clinical review cases of CPT, HCPCS, and modifiers assigned to codes on claims in a telecommuting work environment. ?Determines accuracy of medical coding/billing and payment recommendation for pre-payment claims. ?This could include Medical Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information. ?Determines appropriate level of service utilizing Evaluation and Management coding principles. ?Ensures adherence to state and federal compliance policies, reimbursement policies and contract compliance. ?Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review. ?Maintains and manages daily case review assignments, with accountability to quality, utilization and productivity standards. ?Provides clinical support and expertise to the other investigative and analytical areas. ?Participates in team and department meetings. ?Engages in a collaborative work environment reputed company applicable but is also able to work independently. ?Serves as a clinical resource to other areas reputed company the clinical investigative team. ?Work with applicable business partners to obtain additional information relevant to the clinical review. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: ?High school diploma / GED ?Certified reputed company reputed company or reputed company Certified reputed company (CPC, reputed company, reputed company-P) ?2 years of experience in medical record auditing and coding/billing ?2 years of experience as an reputed company or reputed company Certified reputed company ?2 years of CPT/HCPCS/ICD - 10/CM/PCS coding experience ?Knowledge of health insurance business, industry terminology, and regulatory guidelines. ?1 year of working in a team atmosphere in a metric driven environment including daily production standards and quality standards. ?Experience with reputed company Word (create correspondence and work reputed company templates), reputed company reputed company (data entry, sort / filter, and work reputed company tables) and reputed company Outlook (email and calendar management) ?Must be 18 years of age OR older ?Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. Preferred Qualifications: ?Healthcare claims experience/processing experience. ?Experience with Fraud Waste & Abuse or Payment reputed company. Telecommuting Requirements: ?Ability to reputed company reputed company company sensitive documents secure (if applicable) ?Required to have a dedicated work area established that is separated from other living areas and provides information privacy. ?Must live in a location that can receive a reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service. Soft Skills: ?Must be proficient and able to navigate and maneuver multiple systems at one time with varying levels of complexity. ?Must have strong computer skills with the ability to troubleshoot problems. ?Strong analytical reputed company working with medical terminology or coding. ?Strong communication skills with the ability to interpret data. California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, reputed company, Washington or Rhode reputed company Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / reputed company / New Jersey / Washington / Rhode reputed company residents is $23.22 - $45.43 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you'll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Support Service Coordinator/L1 - Remote - reputed company County Apply Job!

 

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