Coding and Cost Analyst I, Geisinger Health Plan (Easter Standard Time Zone resident)
Core
Reviews billed services, authorizations, and medical records to ensure correct coding, appropriate billing, and accurate reimbursement for Geisinger Health Plan members.
Role type
Senior IC medical coding and cost analysis specialist
Builds
Validated claim payments, recovery recommendations, and department data reports
Domain
Healthcare administration / Medical billing and coding
Required skills
Medical coding (CPT, CMS guidelines), Claims review, Contract validation, Data reporting, Clinical risk analysis, Regulatory compliance
Preferred skills
Pharmacy benefit management, Underwriting analysis, Quality assurance reviews
Technologies
Claim editing software, CPT guidelines, CMS guidelines
Responsibilities
Review and validate pended and reconsidered claims based on CPT and CMS guidelines; Complete clinical reviews for claims, appeals, and grievances; Recommend recovery efforts based on contracts and industry standards; Validate claim payments in collaboration with Pharmacy and PNM departments; Create and maintain reports to track department data; Assist in group discussions on challenging medical reviews.
Seniority
Mid-level, hands-on IC
