[Hiring] Claims Auditor, Reviewer and Coder @Planned Systems International

Role Description

Advanced Technologies & Laboratories International, Inc. (ATL) is hiring a Claims Auditor, Reviewer and Coder. The Contractor shall provide expertise in quality assurance, claims processing, medical coding, and audit activities for the WTC Health Program. Responsibilities include:

• Supporting quality assurance and audit planning
• Conducting claims reviews and audits
• Analyzing claims data to identify trends and issues
• Researching federal payer coverage policies
• Developing and improving program policies and procedures
• Maintaining the health plan codebook
• Ensuring accurate application of medical coding standards
• Recommending improvements to processes and benefit plans based on industry best practices, coding guidance, reimbursement policies, and evidence-based healthcare standards

Qualifications

• A bachelor’s or master’s degree in a health profession (HIM, MPH, MHA, RN, PA, other health profession) preferred
• A minimum of 5 years’ experience working with health insurance payor claims data in a health plan or managed care setting
• Experience in healthcare quality, medical coding, and claims auditing
• Demonstrated expertise in CPT, HCPC, and ICD billing codes, authorization requirements and documentation, DRG, and health care claims data analysis
• Registered health information administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) certification desirable
• Proficient in Microsoft Office Suites, including Excel, Outlook, and SharePoint

Requirements

• MS Office (Word, Excel, PowerPoint, Outlook)
• Communication tools (Teams, SharePoint)

Benefits

• Competitive total compensation package including paid leave
• Options for employer sponsored group medical, dental, vision, short-term and long-term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance
• Flexible spending account and health saving account options for pre-tax savings
• Company sponsored 401(k) retirement plan with an employer contribution match that is immediately vested
• Investment in the professional growth of employees through professional courses, certifications, and tuition reimbursement programs