Job Description:

• Supports most complex medical record audit programs
• Provides Provider Pre Pay production and progress reports
• Recommends process or procedure changes while building strong relationships with cross departmental teams
• Demonstrates leadership ability, including mentoring Program Integrity Audit Analysts
• Identifies knowledge gaps and provides training opportunities to team members
• Coordinates the training of new and existing claims analyst staff
• Analyzes complex provider claims submissions using knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules
• Maintains a working knowledge of all state and federal laws, rules, and billing guidelines

Requirements:

• Associates degree required
• Five (5) years of medical billing and coding experience
• Minimum of three (3) years of SIU/FWA medical billing and coding experience required
• Medicaid/Medicare experience required
• Prior experience with claim pre-payment, medical claim and documentation auditing required
• Three (3) years of experience in Facets preferred
• Experience with reimbursement methodology (APC, DRG, OPPS) required
• Inpatient coding experience preferred
• Leadership experience preferred
• Certified Medical Coder (CPC, RHIT or RHIA) is required at time of hire required

Benefits:

• Comprehensive total rewards package
• Health insurance
• Bonuses tied to company and individual performance