Coding and Reimbursement Specialist

This is a remote, full-time, day-shift position with MediGold.

About MediGold

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, and provider relations.

Position Purpose

As a Coding and Reimbursement Specialist, you will respond to post-payment inquiries from providers regarding claim disposition, serve as a department resource, develop educational resources for providers, and act as the subject matter expert for the Plan in all matters related to provider billing and reimbursement.

Requirements

• High School degree required; Bachelor's degree preferred.
• CPC, CPC-P, or equivalent certification preferred.
• Minimum of 5 years experience in claims auditing, billing, and/or coding.
• In-depth knowledge of current Medicare coding and billing requirements.
• Knowledgeable in multi-specialty coding and billing requirements.
• Extensive knowledge of auditing concepts and principles.
• Advanced knowledge of current medical terminology, anatomy, and physiology.
• Advanced knowledge of current ICD-10, CPT-4, and HCPC coding principles and documentation guidelines.
• Extensive knowledge of Medicare regulations and policies pertaining to documentation, coding, and billing.
• Strong written and verbal communication skills to clearly articulate complex regulatory information to internal and external customers, including physicians, practice managers, and billing staff.

Responsibilities

• Review and respond to post-payment inquiries from providers.
• Process pended claims to ensure integrity of claim payment to providers and members.
• Work with provider credentialing to ensure proper set-up for accurate payments.
• Process and review requests from members for reimbursement.
• Proactively identify trends through auditing and internal reporting; develop and present reports of findings to Health Plan leadership.
• Develop and maintain effective working relationships with providers and their billing staff.
• Perform responsibilities of Claims Auditor as time and workload permit.
• Assist in developing tools and presentations on documentation, coding, billing, and other topics for the provider community.
• Attend coding and billing conferences, workshops, and in-house education sessions to stay current with regulations.
• Analyze claims processes to identify potential areas of fraud, waste, and abuse; provide recommendations for process improvements.
• Assist with the release of claims pended for coding issues.

Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition and professional development reimbursement.
• Relocation assistance (geographic and position restrictions apply).
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing.
• Employee Referral Rewards program.
• DailyPay: Eligible colleagues can see daily earnings and transfer money before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

About Mount Carmel

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients annually at hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary and specialty care physician offices, community outreach sites, and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs.