PI Medical Coding Reviewer III (CPC, RHIT or RHIA required)

Job description

Job Summary: The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes. Essential Functions: - Provide Provider Pre Pay production and progress reports and coordinate with management and team on recommendation for further actions and/or resolutions in order to increase team performance - Recommend process or procedure changes while building strong relationships with cross departmental teams such as Claims, Configuration, Health Partners, and IT on identified internal system gaps - Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts to identify and perform oversight and monitoring of claims decisions based on documentation. - Identify knowledge gaps and provide training opportunities to team members - Coordinate the training of new and existing claims analyst staff to increase recognition of improper coding, documentation, and/or FWA - Identify and assist in correction of organizational workflow and process inefficiencies - Serve as the primary resource for provider pre-pay team - Use concepts and knowledge of CPT, ICD10, H...