Job Description:
• Identify and investigate healthcare billing activities leading to improper payments
• Review claims data and conduct analysis to look for patterns of potential improper payments
• Conduct data analysis to review claim and case history
• Review claims history, medical reviews, provider files, etc.
• Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets
Requirements:
• Bachelor's degree or 4 – 6 years of equivalent work experience in healthcare administration, billing, claims adjudication, clinical auditing, payment integrity operations and/or healthcare reimbursement
• CPC, CCS or other relevant clinical/coding certifications strongly preferred
• Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
• Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
• Strong critical-thinking, communication and attention to detail skills
Benefits:
• Health insurance
• Retirement plans
• Paid time off