Medical Coding Specialist
3 weeks ago
Job Summary
The Payment Integrity Analyst at Athari will play a crucial role in developing a strategic roadmap to recover, eliminate, and prevent unnecessary medical-expense spending. This will involve supporting the execution of a comprehensive claim accuracy program, optimizing pre/post claim editing, auditing, and claim recovery programs to drive incremental value year over year.
Key Responsibilities
- Assist in the development of a stellar payment integrity unit capable of proactively identifying and investigating payment issues and working with stakeholders to develop mitigation strategies to prevent future occurrences.
- Identify overpayment/underpayment opportunities by data mining, investigation, and quality review on benefit and/or provider configuration, rate loads, rate assignments, COB, claims payment logic, etc.
- Support the execution and maintenance of a corporate claim accuracy program by optimizing pre/post claim editing, auditing, and claim recovery programs.
- Assist in the development and deployment of mitigation strategies to avoid future overpayments, driving incremental value year over year in both medical and administrative cost savings.
Requirements
- Bachelor's degree required
- A minimum of 5 years' working experience within claims in the healthcare or insurance industry
- Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation
- Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes
- Must understand trend information and be familiar with claim coding practices and industry issues in Medicare payment methodologies
- Advance level experience with Excel and other data systems
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