Offer summary
Qualifications:
Bachelor's Degree or equivalent experience, Certified Coding Certification within 24 months, 3 years in claims processing operations, 2 years in auditing or reporting systems, Knowledge of health insurance legislation.
Key responsabilities:
- Perform clinical and billing reviews for claims
- Document findings and research as needed
- Coordinate with various departments on cases
- Ensure compliance with URAC and NCQA standards
- Utilize medical, contractual, and policy information