Inpatient Coder Associate, Payment Integrity
Core
Ensure accurate payment of medical claims and reduce inappropriate medical spend by identifying provider DRG denials and upcoding.
Role type
Inpatient clinical coder (payment integrity)
Builds
Compliant, efficient, and profitable claims processing programs
Domain
Healthcare insurance / Medical billing and coding
Required skills
CCS or CIC certification, DRG pricing methodology knowledge, inpatient clinical coding experience
Preferred skills
Medicare or Medicare Advantage payment integrity experience, claims operations experience, advanced Excel and PowerPoint skills
Responsibilities
Review claims for DRG related issues on prospective and retrospective basis, Proactively identify overpayments to ensure accurate claims payments, Participate in collaborative discussions with MDs to verify clinical rationale behind billed procedures, Communicate with multi-discipline teams to ensure accurate claims adjudication and proper provider notification
Seniority
Associate, entry-level to mid-level
