Case Reviewer/Coder
Responsibilities
- Chiefly responsible for reviewing provider dispute documentation for accuracy of original claim, and updating claims in HWT database
- Summarizes and documents specifics of the review
- Reviews and resolves provider disputes in a timely manner consistent with the goals of HWT and its clients
- Manages own PR case work load, ensuring expedient resolution for all provider dispute
- Communicates directly with providers regarding disputes
- Creates weekly analysis of case log, working with other PR personnel and/or managers to ensure appropriate rate of closure
- Works with other PR personnel on a daily basis, delegates tasks where appropriate
- Works as an integral part of a client team
- Participates in early stage client/project planning
- Works with Client Manager to identify potential disputes
- Ensure appropriate levels of PR capacity
- Works collaboratively with Algo Development team to communicate disputes, trends, concern, ideas
- Participates in innovation processes to develop new tools and strategies to enhance PR performance
- Actively identifies and shares best practices
- Develops tools for active knowledge sharing and management
Education
Bachelor's or advanced degree in medicine or nursing, hospital or medical services.
Experience Guidelines
- The ideal candidate will have extensive experience as a certified medical coder, RN, etc.
- 2-5 years of medical claims coding/processing experience
- Comfort and experience with computers, IT systems in general
- Ability to work collaboratively on multi-disciplinary teams
Please send resume and salary requirements to careers@hwtc.com or HWT, Inc. 2 Monument Square, 4th Floor, Portland, ME 04101. Due to the large number of qualified candidates we receive, only those being considered for the position will be contacted. NO PHONE CALLS PLEASE. EOE.
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