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Coding and Cost Analyst I

Review Geisinger Health Plan claims, coding, and reimbursement, and recommend potential recoveries. Validate high-dollar claim payments against healthcare regulations and plan contracts.

USAmerika Qo‘shma ShtatlariPAPensilvaniyaGibridTo‘liq stavkaO‘rta darajaSeniorTalab Qilinadigan Til: inglizchaTahlilchi

Tavsif

  • Review billed services, authorizations, benefit documents, itemized statements, medical records, discharge summaries, and detailed reports.
  • Recommend reimbursement or recovery based on coding, billing data, policies, industry standards, contracts, and applicable regulations.
  • Advise Health Plan departments on accurate coding, billing, and reimbursement.
  • Conduct clinical reviews for claims, claim edits, appeals, and grievances.
  • Help assess clinical risk for Underwriting, Pharmacy, and Finance.
  • Recommend recoveries in line with contracts, policies, procedures, and industry standards.
  • Review and validate pended and reconsidered claims using CPT, industry, and CMS guidelines.
  • Review high-dollar inpatient and outpatient claims and support quality concern reviews.
  • Validate claim payments against plan contracts in coordination with Pharmacy and PNM departments.
  • Create and maintain departmental tracking reports.
  • Join discussions about complex medical reviews.
  • Help onboard new team members.
  • Participate in assigned workgroups and committees.

Talablar

  • High school diploma or GED required.
  • AAPC Certified Professional Coder (CPC) or AHIMA Certified Coding Specialist (CCS) credential required.
  • At least three years of relevant experience required.
  • Relevant experience may include related work and completed specialty training.
  • One year of specialty training counts as one year of relevant experience.
  • LPN credential preferred.
  • At least two years of clinical experience preferred.
  • Computer literacy.
  • Critical thinking skills.
  • Organizational skills.
  • A secure home office that meets HIPAA Privacy standards.
  • Ability to follow organizational policies and procedures.

Imtiyozlar

  • Healthcare coverage for full-time and part-time employees starting on day one.
  • Vision coverage.
  • Dental coverage.
  • Domestic partner benefits.
  • Work-from-home arrangement.
  • Occasional onsite department meetings as needed.

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