Conduct retrospective medical claims reviews for coding and pricing determinations and/or inpatient facility coding review, including diagnosis and procedure coding with DRG assignment.
Serve as a subject matter expert on outpatient and inpatient medical claims coding and provide coding-related support to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and subcontractors.
Lead coding projects, support committee and project work, and act as the designated recipient for factual network provider claim review requests.
Develop determination letters, conduct validation reviews of automated systems, and support clinical and non-clinical staff on coding and retrospective claims review processes.
Work remotely from home and may be assigned any shift.
High school diploma or GED.
Current certification as Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
U.S. citizenship.
Ability to receive a favorable interim and final Department of Defense background investigation.
Minimum 5 years of clinical coding experience for facility and/or professional accounts.
Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts.
Documented experience working in a fast-paced environment.
Preferred:
Experience in the private medical industry, health insurance, or managed care.
Familiarity with TRICARE and the military healthcare delivery system.
Certified Electronic Health Records Specialist (CEHRS).
Medical, dental, and vision coverage.
Paid time off.
401(k) retirement savings plan with matching.
Short-term and long-term disability coverage.
Basic life and accidental death and dismemberment insurance.
Tuition reimbursement.
Paid volunteer time.
Potential for frequent pay raises, overtime opportunities, and recognition and reward programs.
Location
Phoenix, Arizona, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$63,000 - $74,000
Remote work allowed
Yes
Posted
1 month ago