Job Description: Coder, Bill Reviewer, and Payment Integrity Reviewer

Employment Type: Full-time Location Type: Remote

Position Overview

Dane Street is seeking highly motivated Coders, Bill Reviewers, and Payment Integrity Reviewers to join our team. This role offers an exciting work environment, competitive compensation, and strong growth potential. As part of a new program on the group health side of our business, you will apply your clinical knowledge to review reports accompanying medical records, ensuring the accuracy of medical billing and coding. You will collaborate with other reviewers and their office teams to ensure clarity of information, address all questions, and meet client deadlines.

Core Duties & Responsibilities

• Evaluate the appropriateness of codes and ensure they meet established program standards.
• Verify that medical records are appropriately matched to codes, obtaining them if necessary.
• Read and apply policy guidelines and healthcare terminology, delineating when criteria are met.
• Evaluate claims for conflicts of interest and criteria appropriateness.
• Work within established timeframes set by program parameters.
• Provide strong customer service skills, working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance of cases.
• Offer clinical oversight for complex cases requiring additional review before returning to the client.
• Serve as an additional level of QA and clinical knowledge/review for cases with quality issues.

Requirements

Required Education & Experience:

• Must possess a CPC, APCC, or DRG coder certification.
• Payment integrity or professional bill review experience is strongly preferred.
• Out-of-network bill review experience is a plus.
• Experience working in a remote environment is preferred.
• Experience in a medical office or healthcare background.

Required Skills:

• Ability to work with a sense of urgency and meet deadlines.
• Must be self-motivated with a strong drive for performance excellence.
• Excellent written and verbal communication skills.
• Proficiency in navigating various computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
• Attention to detail is REQUIRED.

PLEASE BE AWARE: In the interest of the security of both parties, Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Benefits

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you are an outstanding candidate, thrive in a fast-paced environment, and are interested in doing meaningful work that impacts others' lives, we encourage you to apply!

About Dane Street

Dane Street is a fast-paced, Inc. 500 Company with a high-performance culture, seeking insightful, astute, and forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Additional Details:

• Published: 2024-02-02
• Department: [Not Specified]