Medical Coding Auditor II
4 days ago
Healthcare Management Administrators (HMA) is a leading third-party health plan administrator in the Pacific Northwest and beyond. We deliver customized health plans to medium to large-size employers, offering high-quality, affordable healthcare options with best-in-class customer service.
Our CultureWe're proud to be recognized as a 'Washington's Best Workplaces' by our staff and the Puget Sound Business Journal for three consecutive years. Our vision, 'Proving What's Possible in Healthcare,' and values, People First, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture and drive our results.
What We're Looking ForWe're seeking unique individuals who care deeply about others, thrive in evolving environments, and are motivated by tackling complex challenges. You'll be part of a team that's inclusive, flexible, and fun, with opportunities for personal development and growth.
Job SummaryWe're looking for an experienced Certified Professional Coder (CPC) to join our payment integrity efforts for self-insured clients. As a Coding Auditor II, you'll apply coding expertise, medical claims knowledge, and critical thinking skills to perform timely and accurate audits of medical claims invoices.
Key Responsibilities- Apply coding expertise and medical claims knowledge to perform audits of medical claims invoices
- Consistently complete allocated audits within the current turn-around time (TAT) of three business days for 80% of reviews
- Become a subject matter expert on coding guidelines and collaborate with internal teams and external stakeholders
- Provide accurate and timely support for HMA responses to provider disputes of CPR determinations
- Contribute to efficient and effective medical claims review processes and practices
- Current Certified Professional Coder (CPC) certificate required
- 3-5 years of health plan experience
- 3+ years of medical code auditing experience
- 3+ years of experience with Microsoft Office applications (Outlook and Word) and Adobe
- Experience in applying common coding and billing standards
- Strong problem-solving and critical thinking skills
- Strong client-facing verbal and written communication skills
We provide a comprehensive total rewards package, including competitive pay, annual incentive, wellness programs, medical, dental, and vision insurance, 401K retirement plan with match, generous PTO and holidays, and more. As a remote workforce, we require a reliable internet connection and provide all necessary hardware. Some roles may require on-site work 1-3 days per week/month, while others are 100% remote.
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