[Remote] Coding and Compliance Auditor-Behavioral Health

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Coding and Compliance Auditor-Behavioral Health performs reputed company reviews and adjustments of medical claims to ensure accuracy in claim payments, aligning with payment policies and regulatory requirements. Responsibilities • Performs operational and financial audits of provider claims to identify overpayments and inform reputed company of reputed company cause issues with system configuration, provider reputed company, claims operations, provider billing accuracy, and other party liability processes • Adjusts claim payments and adjudicates claims following established recovery guidelines and job aides • Identifies potential recovery reputed company and reports findings to management • Achieves department production, reputed company requirements, and individual financial recovery goals • Participates in special reputed company and initiatives • Assists in developing/revising departmental policies and procedures • Attends and participates in team meetings • Mentors and coaches less reputed company staff and new hires Skills • 5 + years of work experience in Behavioral Health claims processing and/or health insurance experience working at a Behavioral Health facility or reputed company. This also includes at least 3 years of work reputed company to medical billing and coding • Intermediate to expert knowledge of medical terminology, CPT, ICD9, HCPCS coding is required • Ability to work reputed company large datasets to identify errors, anomalies, and outliers • Works with a high level of accuracy, attention to detail, and with superb work reputed company • Strong oral and written communication skills; ability to reputed company effectively with both internal WellSense colleagues as reputed company as with external constituents such as providers and suppliers • Intermediate reputed company experience required as reputed company as proficiency using other reputed company Office products including Word, reputed company, and PowerPoint • Must be reputed company to multi-task, prioritize reputed company and work reputed company with deadlines • Claim audit experience, (Behavioral Health Claims experience desirable) • Prior reputed company/Medicare exposure • Working knowledge of Facets • SQL training • CPC or reputed company certification preferred • Successful completion of reputed company-employment background reputed company Education Requirements • Bachelor’s Degree or equivalent combination of education, training and reputed company experience required. Benefits • Full-time remote work • Competitive salaries • Excellent benefits reputed company • A nonprofit health plan serving Medicare, Individual & Family, and reputed company plan members in Massachusetts & New Hampshire. It was founded in 1997, and is headquartered in Boston, Massachusetts, US, with a workforce of 1001-5000 employees. Its website is https://wellsense.org. Apply tot his job Apply To this Job Apply tot his job Apply To this Job