3 coder lll jobs found

Compliance Program AssistantAssists in the MedStar Family Choice compliance program related to program integrity. Conducts provider audits to identify and address improper billing practices. We recruit, retain, and advance associates with diverse backgrounds skills and talents equitably at all levels.Primary Duties and ResponsibilitiesAnalyzes current payment policies and makes recommendations to improve program integrity and organizational processes.Assists with and tracks responses to external government inquiries investigations data requests subpoenas and fair hearings. Responds to government requests for claims data/information.Prepares written audit reports and communicates the results to management. Initiates corrective action plans or continuous improvement plans identified through audits.Coordinates monthly exclusion data base checks review and report findings.Completes assigned routine and selected audits all within assigned time frames. Ensures timely completion of risk...

Thank you for considering Progyny! Progyny is seeking a Claims Audit Extern to join our team. This role will primarily support claims audits, quality assurance reviews, and other related audit activities. In this role, you’ll gain hands-on experience in healthcare claims auditing while working with provider clinics and cross-functional teams to support coding accuracy, compliance, and continuous improvement. What you'll do... Participate in claims audits and quality assurance reviews, including selecting and preparing patient claim samples, evaluating claims and provider documentation, validating CPT/HCPCS and ICD-10-CM coding, modifiers, billing accuracy, and adherence to applicable coding and documentation guidelines. Document audit findings and prepare audit reports, including workpapers, Executive Summaries/Management Response Forms, and other required audit documentation. Provide education to provider clinics and applicable stakeholders regarding audit...