Claims Auditor, Reviewer, Coder

Jobtailor; Deutschland; Vor Ort; EUR 65.000 - 90.000; Vollzeit

Benefits dieser Stelle

MS Office proficiency

Zusammenfassung

Jobtailor in Germany is seeking a qualified professional to lead quality assurance, claims processing, and medical coding activities within a health plan setting. You will conduct audits, analyze claims data, and support policy development to improve coverage and coding accuracy.

The role emphasizes collaboration with clinicians, administrators, and federal staff, requiring 5+ years in payor data and expertise in CPT/HCPCS/ICD coding. Strong MS Office skills are essential.

Qualifikationen

• A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA).
• Minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting.
• Experience in healthcare quality, medical coding, and claims auditing.
• Demonstrated expertise in CPT, HCPC and ICD billing codes.
• Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint.
• RHIA, RHIT or CCS certification desirable.

Aufgaben

• Provide expertise in quality assurance, claims processing, medical coding, and audit activities.
• Support quality assurance and audit planning.
• Conduct claims reviews and audits.
• Analyze claims data to identify trends and issues.
• Research federal payer coverage policies.
• Develop and improve program policies and procedures.
• Maintain the health plan codebook.
• Ensure accurate application of medical coding standards.
• Recommend improvements to processes and benefit plans based on industry best practices.
• Interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts

Kenntnisse

Quality assurance

Claims processing

Medical coding

Auditing

CPT/HCPCS/ICD

Data analysis

Policy development

Stakeholder collaboration

MS Office

Ausbildung

Bachelor’s or Master’s degree in health profession

Tools

Excel

Outlook

SharePoint

Jobbeschreibung

Responsibilities

• Provide expertise in quality assurance, claims processing, medical coding, and audit activities
• Support quality assurance and audit planning
• Conduct claims reviews and audits
• Analyze claims data to identify trends and issues
• Research federal payer coverage policies
• Develop and improve program policies and procedures
• Maintain the health plan codebook
• Ensure accurate application of medical coding standards
• Recommend improvements to processes and benefit plans based on industry best practices
• Interface and collaborate with clinicians, medical administrators, federal staff, contract staff, and occupational health subject matter experts

Requirements

• A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA)
• A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting
• Experience in healthcare quality, medical coding, and claims auditing
• Demonstrated expertise in CPT, HCPC and ICD billing codes
• Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint
• Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable

Core Competencies

Demonstrates expertise in quality assurance, medical coding, and claims auditing within healthcare settings, with a strong focus on analyzing claims data and improving program policies. Proficient in collaborating with various stakeholders to enhance processes and ensure compliance with medical coding standards.