Tech Stack

Description

You will support process improvement and issue resolution in the claim environment, ensuring claims are paid accurately and timely. You'll leverage deep understanding of claim infrastructure to work cross-functionally, translating stakeholder friction into actionable improvements.

Requirements

• Bachelor's degree or 4+ years commensurate experience
• 4+ years experience in claims processing, coding, auditing, or health care operations
• 4+ years experience in medical coding
• Medical coding certification (CPC, COC, CCS, RHIT, RHIA)
• Experience with reimbursement methodologies and claims processing/resolution

Responsibilities

• Provide expertise on internal claims processing edits, vendor edits, and reimbursement policies
• Identify claims payment issues from data mining and process monitoring, providing scoping and remediation steps
• Respond to inquiries and disputes regarding policies and edits
• Document coding rules and recommend reimbursement policy language and scope
• Translate payment integrity opportunities into business requirements and collaborate with partners