Medical Coder

System One; Village of Tarrytown (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health insurance customer is seeking a Medical Coder Representative to optimize quality performance and ensure an excellent experience for members. This fully remote role includes responsibilities in patient engagement, managing health plan benefits, and compliance with regulatory standards. Applicants should possess a bachelor's degree, relevant coding certifications, and a solid foundational experience in healthcare settings.

Benefits

Health and welfare benefits coverage

Participation in a 401(k) plan

Qualifications

• 3+ years of experience in a health plan or large provider practice.
• Ability to handle multiple priorities and meet deadlines.

Responsibilities

• Ensure patients complete tests and screenings according to NCQA HEDIS recommendations.
• Educate patients on navigating insurance plans and assist with various requests.
• Work with members to refill medications timely.

Skills

Knowledge of Medicare, Commercial and Medicaid Risk Adjustment programs

Working knowledge of medical terminology

Ability to navigate member benefits

Experience with electronic medical records

Knowledge of Quality Concepts such as HEDIS

Education

Bachelors Degree or Equivalent work experience

Certified Risk Adjustment Coder Certification

Job description

Job Title: Medical Coder
Location: N/A, OFFSITE

Type: Contract
Compensation: $35/HR
Contractor Work Model: Remote



ALTA IT Services is staffing a contract-to-hire opportunity for a Medical Coder Representative to support a leading health insurance customer. The individual will report directly to the providers location and is responsible for carrying out the strategy to optimize quality performance while also ensuring that members have an excellent experience with their health plan. This includes maximizing both quality and risk adjustment indicators in addition to assisting members navigate their health plan benefits.

Pay $35/HR
100% Remote
Contract to hire

Must have one of the following:CPC, CPMA, COC through AAPC

Responsibilities:

• Ensure patients complete all relevant test and screenings in accordance with the NCQA HEDIS recommendations.
• Engage patients and shepherd them into care by scheduling appointments with their primary.
• Educate patients on and assist with navigating the various aspects of their insurance plan including but not limited to submitting prior authorizations, determining cost shares, obtaining referrals, checking formularies & finding in-network doctors/services.
• Ensure that patients have an excellent experience while in the providers office and leave in such a way that they are likely to respond positively to experience surveys.
• Fulfill various requests (for patients’ charts, clinical information etc.) made of the provider by the health plan that are normally handled by the providers office staff.
• Work with members to refill medications in a timely manner to ensure proper medication adherence to drugs used to maintain chronic conditions.

Qualifications

• Bachelors Degree or Equivalent work experience.
• 3+ years of working for a health plan, in a large provider practice or some combination of bother experiences.
• Knowledge of the Medicare, Commercial and Medicaid Risk Adjustment programs.
• Certified Risk Adjustment Coder Certification.
• Experience with electronic medical records.
• Experience and strong knowledge of Quality Concepts such as HEDIS, Medication Adherence, CAHPS & HOS.
• Ability to navigate member benefits across multiple product lines including Commercial, Medicaid and Medicare Advantage.
• Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits.
• Ability to handle multiple priorities and meet deadlines.

System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M2

Ref: #855-IT Baltimore