Public - Responsibilities
• Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues on a prospective and retrospective basis that drive inaccurate payments to providers.
• Proactively identify overpayments to ensure accurate claims payments on inpatient services.
• Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
• Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
• Communicate effectively both internally and externally to ensure accurate claims adjudication and proper provider notification.
Public - Required Skills
• You hold a CCS or CIC certification; required.
• Knowledge of DRG pricing methodology; required.
• You have 1-2 years of experience in inpatient clinical coding; preferred
• Medicare or Medicare Advantage payment integrity or claims operations experience; preferred
• You are technologically savvy with strong computer skills in Excel and PowerPoint.
Public - Preferred Skills
• You hold a CCS or CIC certification; required.
• Knowledge of DRG pricing methodology; required.
• You have 1-2 years of experience in inpatient clinical coding; preferred
• Medicare or Medicare Advantage payment integrity or claims operations experience; preferred
• You are technologically savvy with strong computer skills in Excel and PowerPoint.
Public - Schedule/Shift
EST Hours 8-5
Pay: $38.00 - $48.00 per hour
Benefits:
• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Application Question(s):
• Do you have an active CCS or CIC certification?
• Do you have any experience with inpatient auditing and coding for payer side or insurance companies?
Work Location: Remote