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Medicare/Medicaid Claims Editing Specialist
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Job Description
- Req#: 25-633
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Work remotely for employees residing in Massachusetts
- Engage in meaningful work that directly impacts healthcare reimbursement and compliance
- Collaborative work environment with a focus on innovative solutions
- Utilize advanced coding and auditing skills to enhance healthcare operations
What to Expect (Job Responsibilities):
- Develop customized prospective claims auditing and clinical coding policies for compliance with Medicare and Medicaid regulations
- Conduct quarterly and annual reviews of new CPT and HCPCS codes for reimbursement recommendations
- Analyze large claims data sets to identify billing patterns and recommend coding edits
- Collaborate with business partners and vendors to interpret requests and develop new policies
- Perform user acceptance testing and analyze post-production reports for issues
What is Required (Qualifications):
- Bachelor's Degree or equivalent experience
- Minimum of 7 years of healthcare experience, specifically with Medicare and Medicaid
- 7+ years of progressive experience in medical claims adjudication and clinical coding reviews
- Extensive knowledge of Healthcare Revenue Integrity, Payment Integrity, and Analytics
- Proficiency with Optum Claims Editing System (CES), Zelis, and Facets Claims Processing System
How to Stand Out (Preferred Qualifications):
- Certification as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), or Certified Professional Medical Auditor (CPMA) is ideal, or willingness to obtain certification within one year
- Master’s Degree in a related field
#HealthcareServices #MedicalCoding #RemoteWork #CareerGrowth #ClaimsManagement
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