About the job
Are you a passionate billing review professional, CPC coder, or DRG coder? Dane Street is seeking dedicated Coders, Bill Reviewers, and Payment Integrity Reviewers to become part of our dynamic team. We pride ourselves on providing a stimulating work environment, competitive pay, and excellent opportunities for career advancement.
Job Overview:
Our newly launched program on the group health side allows you to leverage your clinical expertise by reviewing reports associated with medical records to verify the accuracy of medical billing and coding. You will collaborate with fellow reviewers and their respective office teams to ensure the clarity and completeness of information, addressing all inquiries, and ensuring timely report submissions in accordance with client deadlines.
Key Responsibilities:
- Assess the appropriateness of codes to ensure compliance with established program standards.
- Match medical records accurately with codes; if discrepancies arise, obtain the necessary documentation.
- Interpret and apply policy guidelines alongside healthcare terminology, clearly identifying when criteria are met or unmet.
- Evaluate claims for possible conflicts of interest and appropriateness of criteria.
- Adhere to established timelines as dictated by program parameters.
- Deliver exceptional customer service, working closely with clients on a case-by-case basis to ensure comprehensive, timely, and accurate quality assurance of cases.
- Provide clinical oversight for complex cases requiring additional review prior to client return.
- Function as an additional layer of quality assurance and clinical insight for cases presenting quality concerns.
