Coding and Reimbursement Specialist

📋 Description

• Review and respond to post-payment inquiries from providers regarding claim disposition and
• Process pended claims and release claims held for coding-related issues to help ensure accurate
• Review member reimbursement requests and help resolve related issues.
• Collaborate with provider credentialing teams to ensure appropriate setup for accurate claim
• Conduct audits and analyze internal reporting to identify trends, risks, and opportunities for
• Develop and present reports and findings to health plan leadership.

🎯 Requirements

• High school diploma required; bachelor's degree preferred.
• At least 5 years of experience in claims auditing, medical billing, and/or coding.
• CPC, CPC-P, or equivalent coding certification preferred.
• In-depth knowledge of current Medicare coding and billing requirements.
• Strong understanding of multi-specialty coding and billing requirements.
• Extensive knowledge of auditing concepts and principles.

🎁 Benefits

• Competitive compensation and benefits package.
• Medical, dental, and vision coverage starting on day one.
• Retirement savings plan with employer match starting day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition and professional development reimbursement.