American Health Plans, a division of American Health Partners, manages Institutional Special Needs Plans (I-SNPs) for seniors in long-term care facilities. This role supports Medicare risk adjustment operations by conducting coding audits, performing post-payment reviews, and preparing provider education correspondence.
The position is remote and supports efforts to improve coding accuracy, documentation quality, and organizational compliance.
Requirements & Qualifications
Required qualifications
- High school diploma or equivalent
- 2 years of experience with complex claims processing and/or coding auditing in the health insurance industry or medical healthcare delivery system
- 2 years of experience in a managed healthcare environment related to claims and/or coding audits
- 2 years of experience using coding and reference materials such as CPT4, ICD-10, HCPCS, and related resources
- 2 years of experience with CMS claims processing and coding requirements, especially skilled nursing and other complex claim rules
- 2 years of experience coding/auditing claims for Medicare and Medicaid plans
- Significant HCC experience, including HCC mapping and hierarchy knowledge
- Coding certification required: CPC or CRC
- Strong knowledge of ICD-9 and ICD-10 diagnostic coding and auditing
- Excellent written and verbal communication skills
- Strong analytical, organizational, and critical thinking skills
- Ability to work remotely without direct supervision
- Ability to manage multiple priorities and maintain confidentiality
Benefits & Perks
Benefits and perks
- Affordable medical, dental, and vision insurance options
- Generous paid time off and paid holidays for full-time staff
- TeleDoc 24/7/365 access to doctors
- Optional short- and long-term disability plans
- Employee Assistance Program (EAP)
- 401(k) retirement plan with company match
- Employee referral bonus program
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago