Remote Coding & Cost Analyst I | CPC/CCS Certified

Geisinger; Elm (PA); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health benefits from day one

Remote work option

Job summary

Geisinger is seeking a remote qualified coder/reviewer to support billing and reimbursement processes. The role involves reviewing billed services, plan documents, and medical records to ensure accurate coding and compliance with CPT, CMS, and contractual standards.

The ideal candidate holds CPC/CCS certifications and has 3+ years of relevant experience in claims review, underwriter functions, and finance collaborations. Onsite attendance at times may be required for department meetings.

Qualifications

• Minimum of a high school diploma or GED; required.
• Graduate from a specialty training program preferred.
• CPC/CCS certifications are required or strongly preferred.
• Experience with claims reviews, coding, and billing processes is expected.

Responsibilities

• Review billed services, authorizations, and plan documents for proper coding and reimbursement.
• Perform clinical reviews related to Claims, Edits, Appeals and Grievance processes; analyze clinical risk.
• Recommend recovery efforts based on contracts, policies, and industry standards.
• Validate claim payments based on Plan contracts; collaborate with Pharmacy and PNM teams.
• Create and maintain reports to track department data.
• Assist onboarding of new team members and participate in workgroups.

Skills

Computer literacy

Critical thinking

Organizing

Education

High school diploma or GED

Specialty training program

Job description

Geisinger is seeking a remote qualified coder/reviewer to support billing and reimbursement processes. The role involves reviewing billed services, plan documents, and medical records to ensure accurate coding and compliance with CPT, CMS, and contractual standards.

The ideal candidate holds CPC/CCS certifications and has 3+ years of relevant experience in claims review, underwriter functions, and finance collaborations. Onsite attendance at times may be required for department meetings.