Tech Stack

Description

You will execute payment integrity solutions, review high-dollar facility itemized bills for billing errors, and ensure claims are paid accurately. Collaborate cross-functionally to identify and remediate claims issues.

Requirements

• Bachelor's degree or 4+ years commensurate experience
• 2+ years of bill/coding audit experience with hospital/facility billing (UB-04)
• 4+ years experience in medical coding
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• Experience with reimbursement methodologies and claims processing

Responsibilities

• Perform line-by-line review of high-dollar facility itemized bills and claim forms (UB-04s)
• Identify and document potential billing errors like duplicate billing, unbundling, charges for non-covered services
• Compare billed charges against payor contracts and industry guidelines
• Apply coding knowledge (CPT, HCPCS, ICD-10, MS-DRGs) to validate codes
• Prepare documentation of findings, savings, policy violations, and claim adjustments