Claims Coding Specialist (Omaha, NE)

IntegriGuard has an opportunity for a Claims Coding Specialist to review healthcare claims electronically to determine accuracy in billing and coding. The successful individual will perform a review of submitted documentation to determine benefit coverage, correct coding, and pricing; complete medical review form, accurately document findings, and provide policy/regulatory support for determination; maintain internal quality control processes to assure the reliability of project reviews; develop and maintain documentation on quality improvement processes; provide support to internal and external customers with respect to Medicare-related issues; conduct claims research using appropriate systems; review provider/supplier submitted claims for payment in accordance with Medicare coverage guidelines; and compare selected claims against edit parameters to verify that claims were appropriately edited for payment denial.

Job Specifications

• Minimum of successful completion of a coding certificate program in an AHIMA approved program.
• High School diploma or GED required.
• RHIT or RHIA preferred; CCS or CCS-P certification will be considered.
• Minimum of two years experience in coding review, as well as ICD-9-CM and CPT-4 coding.
• Minimum of two years experience in using claim pricing software required.
• Advanced knowledge of NCPDP and other types of prescription drug claims is required.
• Working knowledge of DRGs and Medicare coverage guidelines and payment methodologies is required.
• General writing skills and ability to produce work free from typographical and spelling errors.
• Shows longevity in employment with one or more past employers.
• Not currently sanctioned or excluded from the Medicare program by the OIG.
• Working knowledge of Microsoft Office, Internet, and e-mail.

Send your resume to us in one of three ways:

E-mail: humanresources@integriguard.org

Mail:
Human Resources
IntegriGuard
2121 North 117 Avenue, Suite 200
Omaha, NE 68164

Fax: 402.498.2534

IntegriGuard is an Equal Opportunity and Affirmative Action Employer.

Any questions regarding benefits can be directed to: humanresources@integriguard.org