The Program Integrity Medical Coding Reviewer III supports complex medical record audit programs, dispute management, escalation management, and reporting/analysis related to pre-pay and post-paid processes.
This role reviews medical claims using coding guidelines and reimbursement methodologies, supports provider escalation and audit decision-making, and helps improve team performance through reporting, process improvement, training, and cross-functional collaboration.
Requirements & Qualifications
- Associate's degree required; equivalent relevant work experience may be accepted in lieu of education
- 5+ years of medical billing and coding experience
- At least 3 years of SIU/FWA medical billing and coding experience
- Prior experience with claim pre-payment, medical claim, and documentation auditing
- Medicaid/Medicare experience required
- 3 years of Facets experience preferred
- Experience with reimbursement methodologies such as APC, DRG, and OPPS required
- Inpatient coding experience preferred
- Leadership experience preferred
- CPC, RHIT, or RHIA certification required at hire
- Knowledge of CPT, ICD-10, HCPCS, DRG, and revenue coding rules
- Strong understanding of medical billing, claims payment, and reimbursement guidelines
- Proficiency with Microsoft Office Suite
- Excellent written and verbal communication skills
Benefits & Perks
- Bonus eligibility tied to company and individual performance
- Comprehensive total rewards package
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$62,700 - $100,400
Remote work allowed
Yes
Posted
1 week ago
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