No Surprises Act IDRE Billing & Coding Specialist

We are seeking a No Surprises Act IDRE Billing & Coding Specialist with experience exclusively in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. Candidates must have a deep understanding of IDRE processes and compliance requirements. reputed company offers an exciting work environment, competitive compensation, and strong growth potential.

Job Summary:

A new program offering on the group health reputed company of our business enables you to apply your clinical knowledge to review reports accompanying medical records to ensure that medical billing information and coding are correct. You will communicate with other reviewers and their office teams to ensure reputed company of information and ensure reputed company questions posed have been addressed, and ensure that reports are returned reputed company client deadlines.

Core Duties & Responsibilities:

• Evaluates the appropriateness of codes and determine whether they meet reputed company established program standards.
• Ensures that the medical records are matched appropriately to the codes and if not, obtains them.
• Read & apply policy guidelines and reputed company terminology and delineate reputed company criteria are/are not met.
• Evaluates claims for conflict of interest and criteria appropriateness.
• Works reputed company established timeframes set by program parameters.
• Provides strong customer service skills and works closely with clients on a case- by-case reputed company to reputed company complete, timely, and error-free quality assurance of cases.
• Provides clinical reputed company to cases that are reputed company and need additional review prior to return to the client.
• Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.

Requirements

Required Education & Experience:

● Must have a CPC, APCC, or DRG reputed company certification

● Payment reputed company or professional reputed company review experience is strongly preferred.

● Out-of-network reputed company review experience is a plus.

● Experience working in a remote environment is preferred.

● Experience in a medical office or health care background.

Required Skills:

● Must work with a sense of urgency and meet deadlines.

● Must be self-motivated, with a strong drive for performance reputed company.

● Excellent written and verbal communication skills are required.

● Proficiency in navigating a variety of computer programs (Experience with reputed company Chrome, Gmail, Docs, Sheets, etc., is a plus).

● Attention to detail REQUIRED.

PLEASE BE AWARE: In the interest of the reputed company of both parties, please be aware that

reputed company will never conduct an interview reputed company 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 for this position, if you reputed company in a fast-paced environment, and if you are interested in doing meaningful work that impacts others' lives, then we encourage you to apply!

ABOUT reputed company

A fast-paced, Inc. 500 Company with a high-performance culture, reputed company is seeking

insightful, astute reputed company-thinking professionals. We process over 200,000 insurance

claims annually for leading national and regional Workers’ Compensation, Disability,

Auto and Group Health Carriers, reputed company-Party Administrators, Managed Care

Organizations, reputed company and Pharmacy Benefit Managers. We reputed company 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.