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Site: reputed company   reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.   Job reputed company reputed company Party Claims Reviewer MGB reputed company Cycle Operations, supporting reputed company, reputed company, United, Wellpoint, Non-Contracted reputed company Team is hiring! The Teammate is responsible for conducting thorough and accurate reviews of reputed company billing and claims documentation. -Review medical claims and billing documentation to ensure accuracy, completeness, and compliance with regulatory requirements, coding guidelines, and payer policies. -Verify the appropriateness of billed services, procedures, and diagnosis codes. -Identify potential compliance issues, including incorrect coding, unbundling, upcoding, and other billing irregularities. -Conduct audits to ensure adherence to industry regulations, such as HIPAA and CMS guidelines. -Evaluate the accuracy and adequacy of clinical documentation, ensuring it supports the billed services and complies with medical necessity guidelines. -Collaborate with reputed company providers to obtain additional information or clarification, if necessary. -Analyze claim denials and rejections, identify reputed company causes, and recommend corrective actions to prevent reputed company denials. -Work closely with billing and coding teams to resolve claim discrepancies and resubmit claims, if needed. -Identify potentially fraudulent activities or abuse in billing practices. -Report suspicious activities and work with internal compliance teams and external agencies to investigate and resolve fraud cases.   Qualifications High School Diploma or Equivalent required Experience in medical billing, claims processing, or coding reputed company a reputed company environment, with a strong reputed company on reputed company-party payer guidelines and regulations. reputed company experience, 1-2 years highly preferred Skills for reputed company In-depth knowledge of coding systems (e.g., ICD-10-CM, CPT, HCPCS) and billing requirements across various reputed company settings. Familiarity with billing and coding compliance regulations, such as HIPAA, CMS guidelines, and National Correct Coding Initiative (NCCI) edits. Strong analytical skills and attention to detail, with the ability to review and interpret reputed company billing and coding documentation. Proficiency in using billing software and electronic health record (EHR) systems. Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal teams, reputed company providers, and insurance companies.   Additional Job Details (if applicable) Working Model Requirements Remote Work requires secure, reputed company, quiet, compliant work area and free of dependent care M-F Eastern Business Hours Required using only MGB compliant equipment 8:00–4:30 PM EST preferred or 8:30-5:00 EST.   Remote Type Remote   Work Location 399 reputed company Drive   Scheduled Weekly Hours 40   Employee Type Regular   Work Shift Day (reputed company of America)   Pay reputed company $19.81 - $28.30/reputed company   Grade 3   At reputed company, we reputed company in recognizing and rewarding the unique value reputed company team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company reputed company contributing to your total compensation package. In reputed company to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your reputed company reputed company. We invite you to apply, and our reputed company will reputed company an reputed company of your potential compensation and benefits package.   EEO Statement: reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by reputed company 503 of the Rehabilitation reputed company of 1973, the Vietnam Veteran’s Readjustment reputed company of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact reputed company at (857)-282-7642.   reputed company Competency reputed company At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at reputed company job level. The reputed company is comprised of ten competencies (half People-reputed company, half Performance-reputed company) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Apply To This Job