Coding and Reimbursement Specialist

Trinity Health•Columbus, OH

2d•Remote

About The Position

This is a remote position with MediGold. MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing. The Coding and Reimbursement Specialist responds to post-payment inquiries from providers regarding claim disposition; serves as a department resource; provides/develops educational resources for providers; and serves as the subject matter expert for the Plan in all matters related to provider billing and reimbursement.

Requirements

High School degree required
Minimum of 5 years experience in claims auditing, billing and/or coding.
Must possess an in-depth knowledge of current Medicare coding and billing requirements
Must be knowledgeable in multi-specialty coding and billing requirements
Must possess extensive knowledge of auditing concepts and principles
Advanced knowledge of current medical terminology, anatomy and physiology required.
Advanced knowledge of current ICD-10, CPT-4, and HCPC coding principles and documentation guidelines
Extensive knowledge of Medicare regulations and policies pertaining to documentation, coding and billing
Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers, including but not limited to, physicians, practice managers, billing managers and billing staff at all levels, including the ability to articulate complex regulatory information in layman's terms.

Nice To Haves

Bachelor's degree preferred
CPC, CPC-P or equivalent preferred

Responsibilities

Review and respond to post-payment inquiries from providers
Process pended claims to ensure integrity of claim payment to providers and members
Work with provider credentialing to ensure proper set-up in order to allow for accurate payments
Process and review requests from member for reimbursement
Proactively identify, through auditing and internal reporting, trends. Develop and present reports of findings to Health Plan leadership
Develop and maintain an effective working relationship with providers and their billing staff
Performs responsibilities of Claims Auditor as time and work load permit and dictate
Assist in the development of tools and presentations on documentation, coding, billing, and other topics of interest to our provider community
Attend coding and billing conferences, workshops and in-house education sessions to stay current with coding and billing regulations
Analyzes claims processes to identify potential areas of fraud, waste and abuse. Provides recommendations to improve processes
Assist with the release of claims pended for coding issues

Benefits

Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition/professional development reimbursement.
Relocation assistance (geographic and position restrictions apply).
Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
Employee Referral Rewards program.
DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.
Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.