2 coder certified jobs found

City / State Norfolk, VA Work Shift First (Days) Overview :Sentara Health Plan is currently hiring an Associate Fraud and Abuse Investigator / Certified Professional Coder (CPC) Remote! Status :Full-time, permanent position (40 hours) Work hours :8am to 5pm EST, M-F Location :This position is remote for candidates that live in the following states :VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, OK, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY! With travel to Virginia Beach 1x a year.Job Responsibilities :Responsible for contributing to in-depth investigations for suspected fraud or abuse with respect to provider, pharmacy, employer, member, and broker interactions involving the full range of products.Responsible for contributing to the review of the quality of pharmacy, physician, ancillary and hospital based coding in routine desk audits as well as occasional on-site audits.Contribute to the review of reimbursement systems relating to health insurance claims...

Reviews claims in assigned work queues in Cerner Revenue Cycle including CMG Review and Ambulatory Edit failure work items.Analyzes coding edits, reviews timeline notes, reviews clinical documentation, including provider orders, progress notes, surgical and test results thoroughly to interpret and ensure documentation supports the posted charges.Determines appropriate action needed to resolve coding edits / issues and ensure clean claim submission.Performs coding functions, including Current Procedure Terminology (CPT), International Classification of Diseases, tenth revision, Clinical Modification (ICD-10-CM), documentation review, and claim denial review.Applies appropriate modifiers.Ensures charges / coding are in alignment with the American Medical Association (AMA),Medicare, and Commercial coding guidelines on all claims reviewed.Credits / updates charges and coding as needed.Ensures queues are worked timely and efficiently.Maintains Productivity and accuracy...