Cyber security analyst Jobs in Columbus, GA

Coding Compliance Specialist

Utilize coding certification knowledge and experience to monitor contractual allowances; analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance. Perform claim audits to ensure billing compliance with coding rules and guidelines as well as payer-specific policies. Analyzes revenue cycle processes in order to develop tools and guidelines for educational opportunities. Conducts research initiatives to support overall billing compliance.

Implements process for identifying under-allowed claims using Experian Contract Manager and other available tools

Reviews and analyzes EOBs for identified under-allowed claims

Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans

Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals

Batches appeals, when applicable, by payer or network, by CPT/HCPCS code combination, by error type, or by provider

Compiles and submits appeals and monitors for proper reimbursement

Uses Experian Contract Manager to track appeals and recoveries

Establishes and cultivates helpful and effective contacts in payer or network offices

Establishes follow-up protocol with payers and networks

Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to the Director of Revenue Optimization Management

Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts

Cross-trains and performs appeals analysis within Hospital claims, as needed

Maintains the strict confidentiality required for medical records and other data

Participates in professional development efforts to ensure currency in managed care reimbursement trends

Required:

Five years with insurance claims/related experience, CPT and ICD-10 terminology experience or

Three years of above described experience with a Associates degree or higher in related field

Required:

High school diploma or equivalent

Preferred:

Associates degree or higher

Required:

Up-to-date coding certification; either CPC or coding credentials via AHIMA.

Knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)

Knowledge of medical terminology.

Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel.

Demonstrated skill working in a team-oriented structure to achieve goals.

Must be able to work independently

Preferred:

Experience conducting revenue cycle / billing related audits

Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.

Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment.

Knowledge of major types of practice management system (PMS) and EOB imaging systems.

Knowledge of managed care contracts and compliance.

Demonstrated skill in gathering and reporting claims information.

All applicants must apply at to be considered

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.