PI Medical Coding Reviewer III, CPC, RHIT, RHIA
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Job Description
Medical Coding Reviewer managing complex medical record audits and performance reports. Collaborating across departments and mentoring audit analysts for enhanced coding accuracy and efficiency.
Responsibilities:
- The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs
- Provide Provider Pre Pay production and progress reports
- Recommend process or procedure changes while building strong relationships with cross departmental teams
- Demonstrate leadership ability, including mentoring Program Integrity Audit Analysts
- Identify knowledge gaps and provide training opportunities to team members
- Coordinate the training of new and existing claims analyst staff
- Identify and assist in correction of organizational workflow and process inefficiencies
- Serve as a primary resource for provider escalation support
- Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze complex provider claims submissions
- Maintain a working knowledge of all state and federal laws, rules, and billing guidelines
Requirements:
- Associates degree required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Five (5) years of medical billing and coding experience to include minimum of three (3) years of SIU/FWA medical billing and coding experience required
- Prior experience with claim pre-payment, medical claim and documentation auditing required
- Medicaid/Medicare experience required
- Three (3) years of experience in Facets preferred
- Experience with reimbursement methodology (APC, DRG, OPPS) required
- Inpatient coding experience preferred
- Leadership experience preferred
Benefits:
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
- Bonuses
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