[Hiring] Medical Review Claims Analyst II @CoventBridge Integrity Systems

Role Description

This position is responsible for organization and entry level review of Medicare and Medicaid claims. Responsible for re-pricing and calculation of overpayments for completed Medical Review post pay case reviews and any re-pricing needed for those review that go through the appeal process. Provides support to Medical Review during the course of fraud investigations or other program integrity initiatives such as requests for information needed to complete Medical Review. Applies a working knowledge of medical terminology and coding principles in the re-pricing of Medicare and Medicaid claims. Also performs such duties as keying information into databases, scanning and assisting with reporting function.

Qualifications

• A high school diploma; two-year degree with health-care emphasis preferred.
• Certified Professional Coder (CPC) preferred.

Requirements

• Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program; and must have no conflict of interest (COI) as defined in § 1154(b)(1) of the Social Security Act.
• Maintain a valid driver’s license for the associate’s state of residence.
• Extensive knowledge of medical terminology and coding principles.
• Knowledge of Medicare guidelines and coverage is also required.
• Ability to read Medicare/Medicaid claims, both paper and electronic, and a basic knowledge of the Medicare claims systems is required.
• Working knowledge of Medicare Claims pricing and payment systems and working knowledge of Medicaid pricing and enhanced rates for states.
• Excellent oral and written communication skills.
• Ability to work independently with minimal supervision.
• Ability to work in MS Office environment.
• Extensive knowledge of medical terminology and experience in the analysis and processing of Medicare claims is required as well as experience related to the specific workload of the individual task order, which may be further defined in the Task Order Statement of Work.
• One year or more experience in medical terminology and Medicare claims payment systems/Medicaid claims or has attained CPC certification.

Benefits

• Medical, Dental, Vision plans.
• Life, LTD and STD paid by the employer.
• 401(k) with company match up to 4%.
• Paid Time Off and company paid holidays.
• Tuition assistance after 1 year of service.
• The salary range for this role is $50,000 to $55,000 annually.