As a coding auditor, you’ll be the backbone of our daily operation. In this position, you will be responsible for reviewing, auditing, and repricing medical facility and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. To be successful in this position, you’ll need a strong understanding of Medicare guidelines and a high degree of independent judgment and professional skepticism.
In this role, you’ll get to:
- Be responsible for adjudicating claims to maintain/comply with client contracts and plan documentation
- Determine accurate payment criteria for clearing pending claims based on defined policy and procedures
- Identify claims with inaccurate data or claims that require further review by appropriate team members
- Research unclear and unusual claims
- Maintain productivity goals, quality standards and aging timeframes within a team setting
- Complete special projects as assigned
We’re looking for people with:
- Experience in health plan operations and an understanding of insurance claims processing.\
- An understanding of provider reimbursement practices including capitation, sub-capitation, case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU and RBRVS-based fee schedules, purchased repriced network, and health plan specific schedules
- The ability to understand standard medical billing and coding (i.e. CPT, ICD-10, HCPCS, etc.)
- Integrity and discretion to maintain the confidentiality of members, employee and physician data
- Critical thinking skills and ability to discover and outline systems-related issues independently and within a team
- Excellent interpersonal, oral, and written communication skills
- Strong attention to detail and organization
- The ability to work independently
- Flexibility in a fast-paced environment
- Strong computer skills
Education and Experience Requirements
- High school diploma or GED
- Coding certification (or in-process certification)—a minimum of one of CPC, CIC, COC, or CPMA
- Experience equivalent of 5+ years in an auditing, billing, or coding role that requires a vast knowledge of medical coding and/or Medicare guidelines in the inpatient, outpatient, or provider setting
This is a full-time position. We offer competitive pay and benefits including medical, dental, vision, and life insurance. You will earn paid time off and paid holidays. We also sponsor a 401k and FSA. We provide paid parking conveniently located near our building.
ClaimDOC is a rapidly growing company in Des Moines striving to change the way healthcare works for the better. You’ll find unrivaled support and a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.