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Coding and Compliance Auditor

Integrated Resources, Inc Boston Contractor
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Job Title: Coding and Compliance Auditor
Job Location: Charlestown, MA 02129
Job Duration: 4+ Months (starts in Aug)
 
Responsibilities:
•         The Coding & Compliance Auditor performs complex operational and financial audits of provider claims using established work processes and job aides.
•         The Auditor also mentors less experienced staff.
•         Extensive knowledge of claim processing and policies is required.
•         This position also requires a working knowledge of medical terminology and coding skills to evaluate accuracy of charges according to reimbursement policies, and industry standard billing and coding guidelines as adopted.
 
Key Functions/Responsibilities:
•         Demonstrates expert knowledge and understanding of benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations as well as industry standards for claim adjudication.
•         Performs operational and financial audits of provider claims to identify issues with system configuration, provider contracts, claims operations, provider billing accuracy, and other party liability processes.
•         Adjudicates claims following established recovery guidelines and job aides.
•         Identifies potential recovery projects and reports findings to management.
•         Remains current with claims adjudication processes and internal and external software systems, including Facets, CAD, and Ingenix/Code Manager.
•         Achieves department production, quality requirements and individual financial recovery goals.
•         Ensures multiple audit projects are completed within designated audit deadlines.
•         Participates in special projects and initiatives.
•         Assists in developing/revising departmental policies and procedures.
•         Attends and participates in team meetings.
•         Mentors and coaches less experienced staff and new hires.
 
Qualifications:
Education:
  • Bachelor’s Degree in Healthcare Administration, business related field or an equivalent.
  • Combination of education, training and experience is required.
  • Intermediate knowledge of medical terminology, CPT, ICD9, HCPCS coding
 
Preferred/Desirable:
  • CPC or CCS certification a plus. Experience:
  • 2 or more years’ experience in a progressive role within healthcare or managed care field required.
  • 3 or more years’ experience as a claims analyst required.
  • Working knowledge of Facets claim processing system preferred.
  • Prior Auditing and/or Medical Record review experience desired.
 
Certification or Conditions of Employment:  
  • Strong oral and written communication skills.
  • Ability to interact within all levels of the department.
  • A strong working knowledge of Microsoft Office products.
  • Detail oriented, excellent proof reading and editing skills.
  • Sensitive provider customer service skills.
  • Must be able to multi-task, prioritize projects and work well with deadlines.
  • Must be able to be flexible and willing to perform all necessary and appropriate duties to ensure the attainment of departmental and organizational goals.
 
Working Conditions and Physical Effort:
  • Regular and reliable attendance is an essential function of the position.
  • Work is normally performed in a typical interior/office work environment.
  • No or very limited physical effort required. No or very limited exposure to physical risk.
 

Recommended skills

Medicaid
Managed Care
Claims
Healthcare Common Procedure Coding Systems
Cpt Coding
Claim Processing

Location

CareerBuilder Estimated Salary

Based on Job Title, Location and Skills
$81K
Below Avg. Average Above Avg.

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Coding and Compliance Auditor
Estimated Salary: $73K
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Job ID: 19-12485

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