Medical Claims Reviewer, Associate

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Medical Claims Reviewer, Associate to join our growing team.

Job Summary:

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 member of the Medical Claims Review team and reports directly to the Medical Claims Reviewer, Manager or Operations, Manager.

***This position is remote***

Job Responsibilities:

• Functions as an individual contributor and works under direct supervision.
• Assists with auditing charts and adjudicating claims while ensuring that all regulations are met in a timely manner.
• Assists with reviewing claims prior to payment, resulting in initial determinations.
• Assists with audits of records to identify irregularities or fraud by providers.
• Assists to ensure that billing is conducted in accordance with Current Procedural Terminology (CPT) guidelines.
• Assists in the review of billing of services that were not provided, misrepresentations of services provided, and compliance with policies and procedures.
• Ensures optimal reimbursement while adhering to federal and state regulations and Medicaid policies.
• Assists with working with Provider Support on resolution of provider issues.
• Assists in reviewing, researching, investigating, and replying to inquiries concerning compliance, inappropriate coding, denials, and billable services.
• Understands the software development life cycle (SDLC) and operations release process.
• Demonstrates basic knowledge of operations methodologies, best practices, and procedures; and learns to apply them to projects to ensure that operations objectives are achieved.
• Adheres to CMMI standards and processes.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.

Required Qualifications/Experience:

• 0-2 years of relevant work experience.
• Certified as a Certified Professional Coder-Apprentice (CPC-A).
• Current coding certification from AAPC.
• Knowledge in medical coding and billing procedures.

Preferred Qualifications/Experience:

• Possesses unwavering commitment to customer service and operational excellence.
• Provides customer support as necessary.
• Keeps abreast of new statutory regulations and medical terminology Knowledge of auditing concepts and principles.
• Comprehensive knowledge of medical coding systems, procedures, and documentation requirements.
• Strong analytical and problem-solving skills.
• Strong attention to detail.
• Ability to work within multiple groups of employees, willingly share time, knowledge and information with others.
• Ability to understand business needs, to analyze processes, and to develop alternative solutions.
• Excellent written and verbal communication skills, including ability to convey technical details to providers, clients, and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage inpatient and outpatient claims Ability to analyze and resolve issues.
• Understanding of SharePoint applications, Webex, Skype, etc.
• Knowledge of Microsoft Word, Excel, and Visio, with a working knowledge of the rest of the Microsoft Office suite of applications.
• Demonstrates basic technical knowledge of statutory regulations and medical terminology.
• Demonstrates basic knowledge of auditing concepts and principles.
• Demonstrates basic knowledge of medical coding systems, procedures, and documentation requirements. Domain knowledge of Medicare, Medicaid, or healthcare verticals.
• Shows initiative, enthusiasm, creativity, and resourcefulness in handling assignments.
• Demonstrates flexibility in working under demands and needs of the project.
• Ability to concentrate for extended periods of time and accomplish the given task with minimum oversight. Knowledge of statutory regulations and medical terminology.

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.

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

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.

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 who are 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 be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO 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, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."