Medical Coder

W3R Consulting; New York (NY); À distance; USD 39 000 - 58 000; Plein temps

Résumé du poste

W3R Consulting is seeking a Clinical Editing Dispute Review Analyst 1 for a remote, five-month contract. The role focuses on researching, reviewing, and resolving clinical editing inquiries, disputes, and appeals in collaboration with Medical Directors and provider teams.

Responsibilities include tracking inquiries, coordinating with internal and external partners, and preparing weekly metrics while ensuring compliant documentation and timely resolutions.

Qualifications

• Bachelor's degree with 3+ years in claims operations or customer service, or 5 years equivalent experience.
• CPC certification preferred; enrollment in CPC course within one year if not certified.
• Knowledge of medical coding, claims adjudication, reimbursement methodologies, and clinical editing tools.
• Proficiency in spreadsheets, databases, and claims processing systems.
• Strong analytical, communication, organizational, and problem-solving skills.
• Attention to detail, customer service orientation, and ability to work independently.

Responsabilités

• Research and resolve clinical editing inquiries, claims disputes, and appeals.
• Coordinate with Medical Directors, providers, internal teams, and vendors to obtain necessary information.
• Track inquiries, monitor turnaround times, and maintain review databases and logs.
• Communicate review decisions and resolutions to providers and stakeholders.
• Support claim adjustments, claims research, and appeals processing.
• Prepare weekly metrics, identify trends, and recommend process improvements.
• Ensure accurate documentation and compliance with established procedures.

Connaissances

Medical coding

Claims adjudication

Reimbursement methodologies

Clinical editing tools

Spreadsheets

Databases

Claims processing systems

Analytical skills

Communication skills

Organizational skills

Problem-solving skills

Attention to detail

Independent work

Formation

Bachelor's degree

CPC certification preferred

Outils

Claims processing systems

Spreadsheets

Databases

Medical coding tools

Description du poste

Clinical Editing Dispute Review Analyst 1

Location: Remote

Schedule: Monday-Friday

Job Type: 5 months contract

Job Summary

Responsible for researching, reviewing, and resolving clinical editing inquiries, claims disputes, and appeals. Collaborates with Medical Directors, Claims, Provider Services, and external vendors to ensure accurate claims processing, timely resolution, and appropriate provider reimbursement.

Key Responsibilities

• Research and resolve clinical editing inquiries, claims disputes, and appeals.
• Coordinate with Medical Directors, providers, internal teams, and vendors to obtain necessary information.
• Track inquiries, monitor turnaround times, and maintain review databases and logs.
• Communicate review decisions and resolutions to providers and stakeholders.
• Support claim adjustments, claims research, and appeals processing.
• Prepare weekly metrics, identify trends, and recommend process improvements.
• Ensure accurate documentation and compliance with established procedures.

Minimum Qualifications

• Bachelor's degree and three years of relevant claims operations or customer service experience, or five years of equivalent relevant experience.
• CPC certification preferred; enrollment in a CPC course required within one year if not certified.
• Knowledge of medical coding, claims adjudication, reimbursement methodologies, and clinical editing tools.
• Proficiency in spreadsheets, databases, and claims processing systems.
• Strong analytical, communication, organizational, and problem-solving skills. xuwmhxw
• Attention to detail, customer service orientation, and ability to work independently.