Job DescriptionMedical Coding AuditorThe Bronx, NY$35 - $45 an hour, based on experience Our client is seeking an experienced Medical Coding professional who will be responsible for reviewing, auditing, and repricing medical facility and professional claims for accuracy and compliance.Medical Coding Auditor Summary:Responsible for adjudicating claims to maintain/comply with client contracts and Plan documentationDetermine accurate payment criteria for clearing pending claims based on defined Policy and ProceduresAbility to understand logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)Work high volume of repetitive claimsIdentify claim(s) with inaccurate data or claims that require review by appropriate team membersMaintain productivity goals, quality standards and aging timeframesComplete special projects as assignedResearch unclear and unusual claimsMedical Coding Auditor:??Coding certification required or in processExperience in health plan operations and an understanding of insurance claims processing desiredInsurance Claims or managed care environment preferredAn understanding of provider reimbursement practices including capitation, sub-capitation, case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU and RBRVS-based fee schedules, purchased repriced network, and health plan specific schedulesKnowledge of health insurance, HMO and managed care principlesHigh School diploma or GEDCoding Certification (or in process) ?? minimum of one of CPC, CIC, COC, or CPMAExperience equivalent of 5+ years in an auditing, billing, or coding role that requires vast knowledge of medical coding and/or Medicare Guidelines in the inpatient, outpatient, or provider settingFor more information please call 763-###-#### or simply apply!SDL2017 Associated topics: authorization, bill, clerk, coding, data, insurance, medical billing, medical transcriptionist, number, receivable
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