This role is essential in reviewing hospital claims to ensure appropriate reimbursement and compliance with contracts and regulatory requirements
Job Summary
This role is essential in reviewing hospital claims to ensure appropriate reimbursement and compliance with contracts and regulatory requirements.
The position involves providing educational feedback and reports to Tennessee facilities based on audit findings while identifying potential fraud or subrogation.
Candidates are expected to utilize Enterprise-AI approved tools to uncover opportunities for improvement and drive greater efficiencies within the team.
Matching Summary
This role is essential in reviewing hospital claims to ensure appropriate reimbursement and compliance with contracts and regulatory requirements.
Skills & Requirements
Must-have
ICD-10 CM/PCS knowledge
CPT and HCPCS billing requirements
Provider reimbursement methodologies
Claims material review skills
Microsoft Office proficiency
Nice-to-have
Enterprise-AI approved tools usage
Facets system experience
Care Advance system experience
Proactive problem-solving attitude
Strong interpersonal communication
Key Requirements
Bachelor's degree or equivalent work experience
2 years of facility inpatient/outpatient coding or auditing experience
Active AHIMA certification (CCS) or willingness to obtain within one year