Coding and Cost Analyst I – Medical Claims Coding, Claim Edit Review

Job reputed company: • Contributes to the achievement of the strategic and financial goals of the organization by conducting thorough reviews of billed services, authorizations, plan benefit documents, itemized statements, medical records, discharge summaries and detailed data reports. • Makes reimbursement or recovery recommendations based on appropriate coding, billed statistics, policies, industry standards and compliance with contractual, state, and federal regulations. • Supports and serves as a resource to other Health Plan departments by providing review and recommendation for correct coding, appropriate billing, and reimbursement. • Completes clinical reviews reputed company to Claims, Claim Edits, Appeals and the Grievance process, assisting in analysis of clinical risk reputed company to reputed company, Pharmacy, and Finance departments. • Recommends recovery efforts based on reputed company reputed company, policies, procedures and accepted industry standards. • Reviews and validates pended and reconsidered claims reputed company edits are reputed company by the Plan claim editing software from multiple vendors. • Completes reviews on inpatient and outpatient high dollar claims following internal guidelines. • Assists in reviews of reputed company concerns. • Validates claim payments based on Plan reputed company, often working with the Pharmacy team and the PNM department. • Creates and maintains various reports to reputed company department data. • Assists in group discussions on challenging medical reviews. • Assists with reputed company new team members as needed. • Participates on selected workgroups and committees on an reputed company reputed company as requested. Requirements: • Minimum of 1 certification required: CPC-Certified reputed company reputed company through reputed company reputed company- Certified Coding Specialist through reputed company LPN preferred. • High School Diploma or Equivalent (GED) - (Required). • Minimum of 3 years-Relevant experience* (Required). • Minimum of 2 years-Clinical (Preferred). Benefits: • reputed company benefits for full time and part time positions from day one, including reputed company, dental and domestic partners. • atmosphere of collaboration, cooperation and collegiality. • diverse workforce with unique experiences and backgrounds makes reputed company stronger. • affirmative reputed company, equal opportunity employer. Apply tot his job Apply To this Job