Claims Reconsideration Coder
![]() | ||||||||||||||||||||||
![]() United States, Rhode Island, Smithfield | ||||||||||||||||||||||
![]() 910 Douglas Pike (Show on map) | ||||||||||||||||||||||
![]() | ||||||||||||||||||||||
Job Details
Description
Position Overview The Claims Reconsideration Coder (CRC) is a multidisciplinary Certified Professional Coder accredited through the American Academy of Professional Coders or Certified Coding Specialist accredited through American Health Information Management Association. This role will evaluate medical record documentation by abstracting the pertinent information that supports the services billed to allow a determination for payment or denial on claim submissions that meet the criteria for a medical note review. Relies on sound review methods applied to the content of the medical notes, benefits, payment policies, clinical medical policies, NCCI edits, CMS, coding manuals (CPT, HCPC, ICD-10), and other industry supported resources required to independently make their determination. This role attends bi-weekly meetings with the Medical Director to present claims that require a medical necessity determination. When separate reimbursement is appropriate, the CRC will make the necessary adjustment. If the request is denied, they compose an adverse determination response to the provider. The Coder uses self-directed, decision making and problem solving that directly impacts financial outcomes and results. Duties and Responsibilities: Responsibilities include, but are not limited to:
Qualifications
Qualifications: Required:
Preferred:
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. |