Healthcare Coding Expert, Certified Professional Coder

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute analytical tasks in support of the HFPP program

• Detect fraud, waste, and abuse referrals and leads through HFPP Analytics

• Collaborate on the creation of HFPP analytic reports

• Propel outcome metrics related to referrals and leads shared with Partners

• Analyze health claims data

• Produce study referrals and leads

• Develop comprehensive provider background profiles

• Pinpoint opportunities for Partner collaboration meetings

• Review and assess medical claims for accuracy, completeness, and compliance with insurance policies, coding guidelines, and reimbursement criteria

• Identify schemes involving fraud, waste, and abuse

• Research and scrutinize insurance policies, coding guidelines, and reimbursement criteria

• Engage in quality assurance initiatives to guarantee deliverables meet regulatory requirements, as well as medical and company policies, and industry standards

• Evaluate and address analytic output inquiries from both internal and external stakeholders

• Mentor and guide less experienced professionals

⛳️ Requirements

• Bachelor's degree or equivalent years of work experience

• Over 8 years of experience in healthcare claims analysis

• Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist (CCS) from AHIMA

• Proficient in medical terminology and healthcare coding, including ICD-10, CPT, and HCPCS

• Background in program integrity and healthcare fraud, waste, and abuse activities, including edits, audits, pre-payment and post-payment reviews, investigations, and referrals

• In-depth knowledge of insurance regulations, reimbursement methodologies, and healthcare compliance requirements

• Excellent oral and written communication skills with the ability to present to management-level staff

• Expert-level proficiency in the Microsoft Office suite

• Familiarity with Tableau, Amazon WorkSpaces, Jira, and Confluence

• Working understanding of HIPAA privacy and security regulations

• Capability to work independently with minimal supervision

• Ability to prioritize various tasks and perform effectively under pressure

• Competence to work efficiently in both team-oriented and independent settings

• CFE or AHFI designation is highly preferred

🏝️ Benefits

• Options for medical plans, including some with Health Savings Accounts

• Dental plan choices

• Vision plan availability

• 401(k) plan featuring pre-tax and post-tax contributions with company matching

• Flexible workweeks whenever feasible

• Leave benefits including vacation, sick, personal, holiday, parental, military, bereavement, and jury duty

• Generally 15 days of paid leave per calendar year

• 10 paid holidays annually

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees

• Short- and long-term disability coverage

• Life insurance

• Accidental death and dismemberment insurance

• Personal accident insurance

• Critical illness insurance

• Business travel and accident insurance

• Remote work opportunities