The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines. The successful candidate must be capable of building and maintaining strong working relationships with key internal and external constituents and working effectively in a matrixed environment.
KNOWLEDGE, SKILLS, & ABILITIES
Knowledge of anatomy, medical terminology, and billing
In-depth knowledge of and ability to interpret ICD-10-CM/PCS, HCPCS/CPT,
Knowledge of APR-DRG, MS-DRG codes and DRG grouping systems and Plan benefit designs.
1-2 years’ experience reviewing and auditing medical records, working in a health plan or health insurance, or similar environment.
Ability to identify and abstract information from medical records (paper or electronic) to ensure coding guidelines are met
CERTIFICATE/LICENSE
Active Certified coder (RHIA, RHIT, CPC, CPMA, CIC, COC or CCS-P) required; candidate would need to maintain active certification.
salary: $24 - $24.04 per hour
shift: First
work hours: 8 AM - 5 PM
education: Bachelors
Responsibilities
Work with SIU Investigators assisting in research, discuss to make appropriate coding determinations as needed
Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed
Compare information submitted on the claims to determine amount and nature of billable services as needed
Determines appropriateness of billing and reimbursement as needed
Documents findings for each claim line in a spreadsheet as needed
Summarize findings in a written report as needed
Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed
Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed
Provide Subject Matter Expertise and SIU support to clients as needed
Comply with Privacy and Security standards
Understands and complies with all company Privacy and Security standards
Other duties as needed
Skills
Qualifications
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
