JOB REQUIREMENTS (Education, Experience, and Training):
* Minimum high school diploma or GED along with two (2) years of direct experience in medical claims investigation or data mining / coordination of benefits auditing. Attainment of relevant medical billing and coding certification along with a bachelors' degree in a relevant field are both highly preferred.
* Knowledge of coding type edits and medical claim reimbursement structures and methodologies
* Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
* Experience in applying principles of coding guidelines; federal/state regulations and policies pertaining to coding and billing
* Knowledge in researching state and federal healthcare guidelines, i.e. Medicare and State Medicaid Programs
* Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e. Facets, QNXT, etc.)
* Advanced computer skills and proficiency with Microsoft Excel
* Must be able to prioritize, coordinate, multitask, think outside the box, and be energetic
* Must be able to work independently while maintaining close attention to detail
* Required licensures, professional certifications, and/or Board certifications as applicable
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.