Remote Coding & Cost Analyst I (CPC/CCS)

geisinger; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Healthcare benefits from day one

Vision and dental coverage

Domestic partner benefits

Job summary

Geisinger is seeking a remote Health Plan Coder to review billed services, authorizations, plan documents, and data for accurate reimbursement. The role ensures compliance with contracts, state, and federal regulations while supporting other departments with coding recommendations.

The ideal candidate has CPC or CCS certification, or equivalent, and a minimum of three years of relevant experience, with LPN considered a plus.

Qualifications

• Minimum of 3 years of relevant experience.
• Experience in clinical reviews related to billing and reimbursement.
• CPC-Certified or CCS-Certified coder required; LPN 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 related to Underwriting, Pharmacy, and Finance departments.
• Recommends recovery efforts based on current contracts, policies, procedures and accepted industry standards.
• Reviews and validates pended and reconsidered claims when edits are applied by the Plan claim editing software from multiple vendors.
• Completes reviews on inpatient and outpatient high dollar claims following internal guidelines.
• Validates claim payments based on Plan contracts, often working with the Pharmacy team and the PNM department.

Skills

Computer Literacy

Critical Thinking

Organizing

Education

High School Diploma or Equivalent

Graduate from Specialty Training Program

Job description

Geisinger is seeking a remote Health Plan Coder to review billed services, authorizations, plan documents, and data for accurate reimbursement. The role ensures compliance with contracts, state, and federal regulations while supporting other departments with coding recommendations.

The ideal candidate has CPC or CCS certification, or equivalent, and a minimum of three years of relevant experience, with LPN considered a plus.