Remote Coding & Cost Analyst (CPC/CCS)

Geisinger; Pennsylvania; Remote; USD 60,000 - 75,000; Full time

Job summary

Geisinger is seeking a remote Health Plan coder reviewer in Pennsylvania. You will conduct thorough reviews of billed services, authorizations, plan benefits, and data reports to determine reimbursement and recovery recommendations in line with CPT, CMS guidelines, and contract terms.

Responsibilities include supporting other departments, performing reviews of claims and high-dollar cases, validating payments, and creating reports while adhering to HIPAA standards and organizational policies.

Qualifications

• Minimum of 3 years of relevant experience required.
• Minimum of 2 years clinical experience preferred.

Responsibilities

• Supports and serves as a resource to other Health Plan departments by providing review and recommendation for correct coding, appropriate billing, and reimbursement.
• Completes clinical reviews related to Claims, Claim Edits, Appeals and the Grievance process, assisting in analysis of clinical risk.

Skills

Computer Literacy

Critical Thinking

Organizing

Education

High School Diploma or Equivalent (GED)

Graduate from Specialty Training Program

Job description

Geisinger is seeking a remote Health Plan coder reviewer in Pennsylvania. You will conduct thorough reviews of billed services, authorizations, plan benefits, and data reports to determine reimbursement and recovery recommendations in line with CPT, CMS guidelines, and contract terms.

Responsibilities include supporting other departments, performing reviews of claims and high-dollar cases, validating payments, and creating reports while adhering to HIPAA standards and organizational policies.