Claims administrator jobs in Uniondale, New YorkCreate job alerts

SUMMARY: We're looking for a Coder to join the Cost Outlier Review team. These coders are working with NY Medicaid to review high cost claims (people that have been in the hospital for a long time) and may be up to multimillion dollar claims. They are looking through the codes to ensure that everything is coded correctly before the nurses review to ensure care was delivered properly. It is a team of 3 coders. Must have a very strong understanding of Inpatient coding and NY Medicaid. It is a 6 month contract with the ability to extend further as needed. GENERAL RESPONSIBILITIES: This individual will utilize his/her knowledge and expertise of the review program and coding guidelines to ensure that the assignment of coding/DRG is appropriate and consistent with ICD-10-CM Official Guidelines for Coding and Reporting and AHA Coding Clinic regulations. DUTIES: • Review (re-abstract and recode) hospital medical records to validate that data received is substantiated by information in the medical record., • Make appropriate referrals to Physician Consultants and RN Clinical Reviewers as necessary., • Assist in analysis and reporting of results., • Perform other medical record, utilization and quality assurance review activities as required., • Validate physician consultant DRG review for adherence to coding guidelines., • Assist with DRG training and implementation for staff., • Other duties as assigned. QUALIFICATIONS: • Strong interpersonal skills with the ability to relate effectively to physicians, senior medical, nursing and administrative personnel., • Excellent communication skills (both written and verbal)., • Technical knowledge of coding and DRG validation., • Ability to work independently with minimal supervision. EDUCATION & EXPERIENCE: • Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS) required., • A minimum of one (1) year of hospital experience in the abstracting and coding of inpatient medical records required., • ICD-10 certification, required. PAY: 30-38/hr LOCATION: Remote (ideally located in NY with understanding of NY Medicaid) SCHEDULE: Monday-Friday (40 hours) between 7am-5:30pm

Job Description As a Coding Reviewer, you will be responsible for the general coding validation and verification and preparation of independent dispute resolution reviews from external state and federal agencies in accordance with reporting requirements. Duties include but are not limited to: • Confirm and verify submitted codes for DRG validation., • Apply national coding standards and regulations to the claims and clinical data., • Provide subject matter input and support agency-wide projects., • Other duties as assigned. This position requires working on-site at the Jericho, NY office. Qualifications: • Excellent interpersonal and communication skills, both written and verbal., • Ability to relate effectively with technical, medical, analytical and administrative personnel., • Proficiency in EHR applications, office technology, and Microsoft applications including Word, Excel, and PowerPoint., • Being able to handle sensitive and confidential information., • Ability to work in a team environment and independently. Education & Experience: • Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS)/ Certified Coding Specialist Physician (CCS-P) required., • Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required, • Bachelor’s degree in healthcare administration or health information management preferred., • Minimum of two (2) years of experience abstracting and coding of outpatient medical records for billing., • Some experience in utilization reviews preferred. The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $65,000.00 – $70,000.00. Actual salary range and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget. The salary range listed does not include other forms of compensation or benefits. IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.