At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.
Candidate should be highly motivated, with strong pricing background including experience in platforms such as Facets, Webstrat, and Encoder. This individual must have excellent communication skills, must be analytical, have strong problem solving skills, and have the ability to make quality decisions.
This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
Responsibilities:
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.
Serves as a knowledge expert and maintains up to date working knowledge of pricing guidelines in order to act as a resource for all pricing team members.
Responsible for reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation
Responsible for reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim
Responsible for reviewing adjudication software system’s claim and line items for determination of how to price a claim / line item
Possess ability to work at a computer for extended periods
Performs quality reviews on individual team members ensuring all claims are completed timely and per department standards
Identifies education needs within the department to facilitate pricing accuracy improvement
Works collaboratively with Assistant Director of Pricing to analyze and optimize processes to maintain acceptable productivity rates for each individual team member
Works collaboratively with Assistant Director in developing educational tools for new hire orientation and ongoing department education
Other duties as assigned
Qualifications:
Associates degree preferred.
Minimum of 5 years management experience
Minimum of 5 years related work experience. Prior experience with claim adjudication systems, grouping and pricing software, and other claim adjudication and claim pricing systems. Ie; Facets, Cosmos, CAS, WebStrat, Encoder
Experience with pricing reject resolution
Basic knowledge of medical terminology.
Good knowledge of Microsoft Word, Excel and Outlook
Intermediate mathematics aptitude
Good communication skills
Good organizational abilities
Good comprehension capabilities
Ability to prioritize multiple tasks
Experience with UB/institutional claims
Knowledge of Medicare and Medicaid billing & payment and coverage guidelines
Strong experience in the analysis and processing of claims, quality assurance, CMS payment methodologies (i.e., DRGs, Cost Outliers)
Must be able to work with minimal supervision
Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication
High speed internet (300 Mbps per person recommended) with secured WIFI
Benefits and perks include:
Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents
401(k) with Employer Match - Join the team and we will invest in your future
Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays
Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional
Salary: 65k- 75k
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Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Internet Publishing
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