Medical Coding and Reimbursement Specialist

4 days ago


Nashville, Tennessee, United States ClarisHealth Full time

We are seeking a Medical Itemized Bill Reviewer to join our team at ClarisHealth.

Estimated Salary: $80,000 - $110,000 per year

About the Role:

This position is responsible for interpreting payer reimbursement policies and building rules to adhere to appropriate billing practices on inpatient itemized bills. The ideal candidate will have an extensive background in facility-based coding practices, CMS billing rules, and state-specific reimbursement guidelines.

Responsibilities:

  • Investigate, review, and provide coding expertise in the application of billing practices and reimbursement policies within the claim adjudication process through a thorough document review.
  • Complete high-quality reviews to ensure accuracy of medical coding and billing practices on itemized bills.
  • Generate and maintain rule-based criteria for itemized bill reviews as annual updates occur and client-specific requirements are understood.
  • Maintain and manage daily case review assignments with a high emphasis on quality.
  • Provide support and expertise to other investigative and analytical areas.

Requirements:

  • High School Diploma / GED (or higher)
  • 5+ years of performing inpatient acute care hospital itemized bill reviews, high-cost outlier reimbursement, and repricing of allowed charges
  • CCS or CIC certification
  • CPC certification
  • Experience with ICD-10 CM and DRG coding

Benefits:

  • Remote-first flexible working environment
  • Health insurance, including $0 premium HDHP and $0 deductible PPO options
  • Vision, Dental
  • Company-paid Telemedicine
  • Company-paid Life Insurance
  • Company-paid STD
  • Voluntary LTD
  • Voluntary Life Insurance
  • FIRST-DAY COVERAGE for all benefits above
  • 401(k) with matching, immediate vesting
  • Generous Paid Time Off, including Vacation, Wellness, Floating Holidays, and Volunteer Time Off


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