Job Description:

• provide expertise in quality assurance, claims processing, medical coding, and audit activities
• support quality assurance and audit planning
• conduct claims reviews and audits
• analyze claims data to identify trends and issues
• research federal payer coverage policies
• develop and improve program policies and procedures
• maintain the health plan codebook
• ensure accurate application of medical coding standards
• recommend improvements to processes and benefit plans based on industry best practices
• interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts

Requirements:

• A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA)
• A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting
• Experience in healthcare quality, medical coding, and claims auditing
• Demonstrated expertise in CPT, HCPC and ICD billing codes
• Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint
• Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable

Benefits:

• paid leave
• options for employer sponsored group medical
• dental
• vision
• short-term and long-term disability
• life insurance
• AD&D coverage
• legal services
• identity theft
• accident insurance
• flexible spending account
• health saving account options
• 401(k) retirement plan with employer contribution match
• professional growth through professional courses
• certifications
• tuition reimbursement programs