The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs
Provide Provider Pre Pay production and progress reports
Recommend process or procedure changes while building strong relationships with cross departmental teams
Demonstrate leadership ability, including mentoring Program Integrity Audit Analysts
Identify knowledge gaps and provide training opportunities to team members
Coordinate the training of new and existing claims analyst staff
Identify and assist in correction of organizational workflow and process inefficiencies
Serve as a primary resource for provider escalation support
Use concepts and knowledge of CPT, ICD10, HCPCS, DRG, REV coding rules to analyze complex provider claims submissions
Maintain a working knowledge of all state and federal laws, rules, and billing guidelines

Associates degree required
Equivalent years of relevant work experience may be accepted in lieu of required education
Five (5) years of medical billing and coding experience to include minimum of three (3) years of SIU/FWA medical billing and coding experience required
Prior experience with claim pre-payment, medical claim and documentation auditing required
Medicaid/Medicare experience required
Three (3) years of experience in Facets preferred
Experience with reimbursement methodology (APC, DRG, OPPS) required
Inpatient coding experience preferred
Leadership experience preferred

PI Medical Coding Reviewer III, CPC, RHIT, RHIA

Key skills