High school diploma or GED required: Bachelor's degree preferred 3yrs + of healthcare reimbursement experience such as provider contract development, healthcare claims analysis, medical billing/ coding, patient accounting, claims auditing, and/or revenue cycle improvement. In depth knowledge of coding principles including but not limited to NCCI Edits, CPT, HCPCS and ICD- 10 codes and modifiers" and /or MSDRG, Revenue codesa and APCs In depth knowledge of UB04 and medical (1500) claims formats and requirements. Must have demonstrated experience and knowledge of healthcare claims processing( Medicare, Medicaid and commercial Insurance) including ICD-10-CM codes, HCPCS codes CPT codes, DRGs, physician billing etc. Understanding or medical terminology and anatomy. Understanding of Medicaid required, Medicare and commercial experience a plus. Experience in healthcare auditing, reviewing and validating the accuracy of claims data and accuracy of claims payment. Experience applying published healthcare guidelines such as CMS regulations and coding guidelines to healthcare claims data, Recovery audit experience a plus. |
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