Medical Claims Reviewer, Associate (Remote U.s.)

Description

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Medical Claims Reviewer, Associate

• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?
• Are you an experienced Medical Claims Reviewer, Associate looking for a new challenge?

If so, you might be our next new team member!

Who we need:

An AAPC or AHIMA Certified Professional Coder-Apprentice (CPC-A)

The role of the Medical Claims Reviewer, Associate is to assist team members and clients with respect to billing, documentation policies, procedures, regulations, and requests for clarification of inconsistent, debatable, or non-specific documentation. This role is a Medical Claims Review team member and reports directly to the Medical Claims Reviewer, Manager, or Operations, Manager.

Acentra Health supports a high-volume healthcare data system accessed through multiple web portals. This high-volume system operates out of multiple data centers and must reliably be available to its clients 7x24x365.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

What you’ll do:

Medical Claims Review:

• Functions as an individual contributor using complex information of medical coding and works under the direct supervision of the Manager and Team Lead.
• Assists with audits of records to identify irregularities or fraud by providers, protecting patient confidentiality.
• Assists in reviewing, researching, investigating, and replying to inquiries concerning compliance, inappropriate coding, denials, and billable services.
• Ensures optimal reimbursement while adhering to federal and state regulations and Medicaid policies.
• Takes action during the review of billing of services that were not provided, misrepresentations of services provided, and compliance with policies and procedures.
• Assists in ensuring that intricate billing is conducted in accordance with Current Procedural Terminology (CPT) guidelines.
• Assists with reviewing detailed medical claims prior to payment, resulting in initial determinations.
• Assists with auditing charts and adjudicating claims while ensuring that all regulations are met in a timely manner.
• Assists with working with Provider Support on the resolution of provider issues.
• The reviewer uses their training and knowledge from AAPC or AHIMA, guidance by the Federal and State guidelines, regulations, policies, and procedures by sending documentation requests to the facility or provider, then takes action on the claim by forcing payment or denying for lack of documentation.
• Must maintain 99%-100% accuracy of documentation review.

What you’ll need:

Required Technology Skills / Qualifications / Experience:

• Ability to work on your own and with team members.
• Knowledge of auditing concepts and principles.
• Demonstrates basic knowledge of medical coding systems, procedures, and documentation requirements.
• Knowledge of statutory regulations and medical terminology.
• Demonstrates basic technical knowledge of statutory regulations and medical terminology.
• Demonstrates basic knowledge of auditing concepts and principles.
• Comprehensive knowledge of medical coding systems, procedures, and documentation requirements.
• Understanding of the ICD-10-CM, CPT, and HCPCS coding manuals.
• Understanding of SharePoint applications, WebEx, Skype, etc.
• Newly Certified Professional Coder - Apprentice (CPC-A).
• Knowledge of Microsoft Word, Excel, Teams, OneNote, and Visio, with a working knowledge of the rest of the Microsoft Office suite of applications.

Preferred Qualifications / Experience:

• Knowledge of medical coding and billing procedures.
• AAPC Membership Number.
• Current coding certification from AAPC or AHIMA.
• Certified as a Certified Professional Coder-Apprentice (CPC-A).

Thank You!

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.