Job Summary
A non-profit health insurance company has a current position open for a Remote Program Integrity Coding and Research Analyst.
Individual must be able to fulfill the following responsibilities:
- Analyze complex provider claims submissions
- Take a lead role to determine root cause of provider claim issues
- Identify payment integrity issues with claims reimbursement methodologies
Applicants must meet the following qualifications:
- Bachelor’s in Business Administration or related field or equivalent years of relevant experience
- 5 years of experience in medical coding, to include experience in program integrity coding audit
- Experience with reimbursement methodology (APC, DRG, OPPS)
- Certified Professional Coder (CPC) or equivalent billing/coding designation
- Proficient in Microsoft Office toolset
- Maintain knowledge and stay current with Federal and State Regulatory requirements
