Payment Intelligence Clinical Coder

Consulting - US Chicago, Illinois New York, New York Los Angeles, California


Description

Payment Intelligence Clinical Coder

 

Were passionate, were collaborative, and we are growing.

 

AArete is looking for an experienced Payment Intelligence professional. You are highly analytical with an entrepreneurial spirit and commitment to excellence. You strive in a team environment and have the ability to flip tasks and priorities midstream because you love an exciting challenge. The bar is set high at AArete. There is a lot to do around here and you love getting the job done right.

 

Why AArete? AAretes mission is to increase client profitability while improving the capabilities of our clients people. We believe that any organization can succeed by enriching and empowering its people. Our own people empower our vision to be a premier global management consulting firm that Fortune 500 and leading organizations trust. Derived from the Greek word arete, embodying excellence, goodness and virtue, an extra A was added to honor our founders original partnership at Arthur Andersen & Co. AArete is guided by the following principles: Excellence, Passion, Loyalty to Clients, Stewardship, Family, Community, Sustainability, and Inclusion. 

 

It is an exciting time to join the AArete team. Come join the company named in Vaults Top 50 Firms to Work For, Crain's Chicago Business Fast 50 for a 3rd year, Inc 5000s Fastest Growing Firms list for the 4th consecutive year and Consulting Magazine's Fastest Growing Firms for the 4th consecutive year.

 

The Role. Many vendors provide on-going payment integrity services; however, AAretes Payment Intelligence ensures erroneous payments are identified, understood, recouped and rectified to prevent them in the future. Payment Intelligence addresses provider billing and health plan payment inaccuracies resulting from issues with payment policies, provider contracts, provider data, covered benefits, member eligibility and prior authorizations.

In this role, the individual will be responsible for supporting Payment Intelligence in client delivery. The position will report into a Payment Intelligence Manager with dotted lines to the client engagement managers. In this position, the individual will be the subject matter expert on practices to help our clients ensure proper claims payment through the use of (1) claims analytics, (2) research regulatory and contract requirements, (3) translate business requirements for use by automation/technology teams, (4) configurations setups, and (5) process improvements. This role will also support the internal development of Payment Intelligence initiatives.

 

Primary Responsibilities:

  • Review medical records in comparison to claims in order to support claim as billed
  • Clinically review and apply accept/reject coding recommendations generated by AArete proprietary system through review of corporate policies, regulatory codes, legislative directives, provider contracts, pre-authorizations, medical records, precedent, practice standards or other guidelines, including Current Procedural Terminology (CPT) coding logic/rules.
  • Ability to make decisions as to uphold or overturn appeal decisions
  • Lead the researching, development, identification and root causing of payment accuracy opportunities through enhancing tactics and communicate/coordinate remediation with client counterparts
    • Perform medical record reviews
    • Process appeals based on provider documentation and medical record review
    • Researching coding questions
    • Assisting with identification and creation of preventative measures including educational materials, payment holds, payment policies, etc.
    • Translating business requirements for use by automation and technology teams
    • Develop client and provider education materials to support correct coding
  • Support the advancement of AAretes Payment Intelligence initiatives to drive greater automation, efficiency, and accuracy to claims payment
  • Identify areas of opportunity for Payment Intelligence including new edits and models by staying up to date on current events, changes in regulatory requirements and market trends
  • Prepare deliverables for final review with team leads
  • Exercise excellent judgement and clear and direct communications in all aspects of your work
  • Serve as contact for clients in answering questions related to medical record review and appeals overturns

 

Requirements:

  • Minimum 3+ years of clinical nursing experience
  • Minimum 5+ years at a payer payment integrity, payment accuracy vendor, healthcare payer or provider consulting firm, or other relevant experience as a clinical coder supporting claims, medical record review, appeals, utilization management, or related
  • Clinical coding certification required
  • Strong professional communication skills including written, verbal, interpersonal and in-person presentation expertise
  • Advanced proficiency utilizing Microsoft Excel
  • Strong analytical, data analysis and interpretation skills; and ability to learn methodologies to identify client savings opportunities and put together an actionable business case
  • Enthusiasm for joining a fast-paced, high growth company and be a part of the business architecture of technology applications and tools
  • Interest in taking advantage of career advancement opportunities within AArete and a growing solution offering