Payment Integrity Coder I

About the position

As a Payment Integrity Coder I, you will support the execution of Premera's corporate wide claim payment accuracy strategy through reviewing provider appeals, performing a complete claim review, and offering provider education as part of the appeal review. You will collaborate with the payment integrity team to ensure existing programs, such as claim editing, are working correctly. This role will require coding experience, analytical skills, and solid communication and organizational adeptness. This is a remote/telecommuter position, working from home.

Responsibilities

• Serve as a subject matter expert for claim payment accuracy including pre-payment claim editing, pre-payment claims auditing, contract compliance, post-payment payment integrity solutions, etc.
• Review documentation submitted with a provider appeal related to payment integrity program(s) and render a decision to uphold or overturn the denied charges.
• Perform a complete claim review while working on an appeal to ensure that all charges submitted on a claim are supported by the documentation.
• Ensure provider documentation is complete and meets industry standards.
• Offer improvement recommendations when appropriate.
• Coordinate with internal teams to maintain payment integrity solutions that increase claim payment accuracy.
• Participate in technology/tool updates, testing, and troubleshooting with internal teams and external vendors.
• Manage the scope of multiple inquiries, projects, or audits under minimal direct supervision.

Requirements

• Bachelor's Degree or (4) years of work experience.
• (2) years of analytical experience in a technical, healthcare, or business-related discipline, including (1) year of medical coding experience.

Nice-to-haves

• (3) years of experience as a certified coder with a health plan, provider billing, or revenue cycle management.
• Certified Internal Auditor.

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
• Generous paid time off to reenergize.
• Tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.