Medical Coding Auditor II

How YOU will make a Difference:

As a Certified Professional Coder with HMA, you will have the opportunity to further advance in your career as an integral part of our payment integrity efforts for our self-insured clients. We are looking for an experienced, consultative CPC who will enjoy capturing disallowances due to policies and guidelines and optimizing the processes and efforts of our Coding Policy Review program.

What YOU will do:

• Apply coding expertise, medical claims knowledge and critical thinking skills to perform timely, accurate audits of medical claims invoices according to appropriate guidelines including current Regence policies and provider contracts, industry standards, and company practices.
• Consistently complete your allocation of the total medical bill audits closed each month, with a high percentage of your reviews completed within the current turn-around time (TAT). Our present TAT is three business days for 80% of reviews.
• Become and serve as a HMA subject matter expert on coding guidelines and collaborate effectively with internal teams including Appeals, Claims, Stop Loss, and Care Management and external stakeholders such Regence and providers to deliver a high quality, coordinated claim experience for groups and members
• Provide accurate and timely support for HMA responses to provider disputes of CPR determinations by analyzing provider concerns and delivering verbal and written explanations suitable for external parties.
• Contribute to efficient and effective medical claims review processes, practices, and formal documentation.
• Maintain CPC certification and regularly complete educational and training sessions to expand coding knowledge and understanding.

Knowledge, Experience, and Key Attributes needed for Success:

• Current Certified Professional Coder certificate required
• 3-5 years of health plan experience
• 3+ years of medical code auditing experience
• 3+ years with Microsoft Office applications (Outlook and Word) and Adobe required
• Experience in the application of common coding and billing standards including the American Medical Association CPT (Current Procedural Terminology), the Centers for Medicare and Medicaid Services National Correct Coding Initiative, Optum Coding resource manuals, the UB04 Billing Manual coding guidelines, and the National Uniform Billing Committee
• Strong problem-solving and critical thinking skills
• Strong client-facing verbal and written communication skills
• Motivated self-starter with the ability to work independently
• Enjoys the pace and rhythm of a deadline-oriented environment requiring strong prioritization skills

Disclaimer: The salary, other compensation, and benefits information are accurate as of this posting date. HMA reserves the right to modify this information at any time, subject to applicable law.

How we Support your Work, Life, and Wellness Goals

We offer a comprehensive total rewards package including: competitive pay; annual incentive; wellness programs; medical, dental, and vision insurance; 401K retirement plan with match; generous PTO and holidays; an onsite gym; life, AD&D, short and long-term disability insurances; an Employee Assistance Plan with additional mental health support; free parking and easy freeway access to I-405 and I-520; a stocked kitchen on-site with subsidized snacks and refreshments; year-round wellness activities; monthly events; paid volunteer hours and more!

HMA is primarily a remote workforce, requires a reliable internet connection, and provides all hardware. Some roles are required onsite 1-3 days per week/month while other roles are 100% remote.

A background screen prior to employment is required.

Protected Health Information (PHI) Access Healthcare Management Administrators (HMA) employees may encounter protected health information (PHI) in the regular course of their work. All PHI shall be used and disclosed on a need-to-know-basis and according to HMA's standard policies and procedures.

HMA is an Equal Opportunity Employer