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Medical Coding Auditor - Hilo

Company: On Time Talent Solutions
Location: Hilo
Posted on: May 12, 2022

Job Description:

Medical Coding AuditorHilo, HawaiiAlso known as "The Big Island", Hilo is the largest island in the Hawaiian Islands and is home to rainforests, volcanoes and breathtaking state parks. Also, home to Hilo Medical Center and a variety of other nationally ranked healthcare clinics, the City of Hilo has different roles that can fit what you're looking for in your next role.On Time Talent Solutions is seeking an experienced Medical Coding professional who will be responsible for reviewing, auditing, and repricing medical facility and professional claims for accuracy and compliance.Medical Coding Auditor Summary:

  • Responsible for adjudicating claims to maintain/comply with client contracts and Plan documentation
  • Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures
  • Ability to understand the logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)
  • Work high volume of repetitive claims
  • Identify claim(s) with inaccurate data or claims that require review by appropriate team members
  • Maintain productivity goals, quality standards and aging timeframes
  • Complete special projects as assigned
  • Research unclear and unusual claimsMedical Coding Auditor Qualifications:
    • Coding certification required or in process
    • Experience in health plan operations and an understanding of insurance claims processing desired
    • Insurance Claims or managed care environment preferred
    • An understanding of provider reimbursement practices including capitation, sub-capitation, case rates, global rates, per diems, percentage discounts, usual and customary fee schedules, RVU and RBRVS-based fee schedules, purchased repriced network, and health plan specific schedules
    • Knowledge of health insurance, HMO and managed care principles
    • High School diploma or GED
    • Coding Certification (or in process) - minimum of one of CPC, CIC, COC, or CPMA
    • Experience equivalent of 5+ years in an auditing, billing, or coding role that requires vast knowledge of medical coding and/or Medicare Guidelines in the inpatient, outpatient, or provider setting

Keywords: On Time Talent Solutions, Hilo , Medical Coding Auditor - Hilo, Healthcare , Hilo, Hawaii

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