Medical Coding Auditor II
3 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 supported by 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 our 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 a comprehensive salary, pay transparency, benefits, and time off package, as well as plenty of personal development and growth opportunities.
Job SummaryAs a Certified Professional Coder with HMA, you'll have the opportunity to advance your career as an integral part of our payment integrity efforts for self-insured clients. You'll enjoy capturing disallowances due to policies and guidelines and optimizing the processes and efforts of our Coding Policy Review program.
Key Responsibilities- Apply coding expertise, medical claims knowledge, and critical thinking skills to perform timely, accurate audits of medical claims invoices according to appropriate guidelines, including current Regence policies and provider contracts, industry standards, and company practices.
- Consistently complete your allocation of the total medical bill audits closed each month, with a high percentage of your reviews completed within the current turn-around time (TAT).
- Become and serve as a HMA subject matter expert on coding guidelines and collaborate effectively with internal teams, including Appeals, Claims, Stop Loss, and Care Management, and external stakeholders, such as Regence and providers, to deliver a high-quality, coordinated claim experience for groups and members.
- Provide accurate and timely support for HMA responses to provider disputes of CPR determinations by analyzing provider concerns and delivering verbal and written explanations suitable for external parties.
- Contribute to efficient and effective medical claims review processes, practices, and formal documentation.
- Maintain CPC certification and regularly complete educational and training sessions to expand coding knowledge and understanding.
- Current Certified Professional Coder certificate required.
- 3-5 years of health plan experience.
- 3+ years of medical code auditing experience.
- 3+ years with Microsoft Office applications (Outlook and Word) and Adobe required.
- Experience in the application of common coding and billing standards, including the American Medical Association CPT (Current Procedural Terminology), the Centers for Medicare and Medicaid Services National Correct Coding Initiative, Optum Coding resource manuals, the UB04 Billing Manual coding guidelines, and the National Uniform Billing Committee.
- Strong problem-solving and critical thinking skills.
- Strong client-facing verbal and written communication skills.
- Motivated self-starter with the ability to work independently.
- Enjoys the pace and rhythm of a deadline-oriented environment requiring strong prioritization skills.
The base salary range for this position in the greater Seattle area is $25/hr - $29/hr for a level II and varies dependent on geography, skills, experience, education, and other job or market-related factors. While we are looking for level I, we may consider level II for highly qualified candidates.
In addition, HMA provides a generous total rewards package for full-time employees, including seventeen (17) days paid time off, eleven paid holidays, one paid personal and one paid volunteer day, company-subsidized medical, dental, vision, and prescription insurance, company-paid disability, life, and AD&D insurances, voluntary life insurances, HSA and FSA pre-tax programs, 401(k)-retirement plan with company match, wellness incentive and reimbursement, remote work and continuing education reimbursements, discount program, parental leave, and a charitable giving match.
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