Medical Review Claims Analyst II (Fully Remote)

CoventBridge Integrity Systems; United States; Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Life, LTD, STD

401(k) with company match

Paid time off & holidays

Tuition assistance after 1 year

Job summary

CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.

The company offers a comprehensive benefits package including medical, dental, and vision plans, life, disability coverage, a 401(k) with company

Qualifications

• Extensive knowledge of medical terminology and coding principles, plus knowledge of Medicare guidelines and coverage.
• Ability to read Medicare/Medicaid claims, both paper and electronic, with working knowledge of Medicare claims pricing and payment systems.
• High school diploma required; two-year degree with healthcare emphasis and CPC certification preferred.

Responsibilities

• Maintain workflow balance to ensure re-pricing requests are accurately completed within departmental timeframes.
• Apply working knowledge of medical terminology and coding principles in re-pricing claims and complete assignments meeting quality assurance goals.
• Implement, terminate, and track pre-pay edit requests daily, and prepare monthly prepay saving reports.

Skills

Medical terminology

Coding principles

Medicare guidelines

Education

High school diploma

Two-year healthcare degree

CPC certification

Job description

• Maintain workflow balance to ensure re-pricing requests are accurately completed within departmental timeframes.
• Apply working knowledge of medical terminology and coding principles in re-pricing claims and complete assignments meeting quality assurance goals.
• Implement, terminate, and track pre-pay edit requests daily, and prepare monthly prepay saving reports.

Requirements:

• Extensive knowledge of medical terminology and coding principles, plus knowledge of Medicare guidelines and coverage.
• Ability to read Medicare/Medicaid claims, both paper and electronic, with working knowledge of Medicare claims pricing and payment systems.
• High school diploma required; two-year degree with healthcare emphasis and CPC certification preferred.
• Medical, Dental, and Vision plans.
• Life, LTD, and STD paid by the employer, plus 401(k) with company match up to 4%.
• Paid Time Off, company paid holidays, and tuition assistance after one year of service.

CoventBridge Integrity Systems

CoventBridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.