Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
- This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
- Perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims, including Part A/B, DMEPOS, and Home Health/Hospice
- Assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs)
- Apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules
- Document clear, accurate findings for each claim
- Participate in dispute resolution by re-examining claims and providing supporting documentation
- Support quality assurance through audits and ongoing training
- Maintain compliance with CMS security and privacy standards
- Collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities
- Qualifications
- 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment
- 3+ years working in a productivity-based claims or case working environment, out of a queued case management system
- 3+ years working remotely with various technology systems
- 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program (preferred)
- Experience with low-code, no-code case management systems as an end-user (preferred but not required)
- Requirements
- Active license as a Registered Nurse, in good standing, in the United States (as verified by Nurses)
- Location
- Remote (United States)
- Salary
- $65,000-80,000
- Company Description
- J29, Inc. is committed to hiring and retaining a diverse workforce
- Proud to be an Equal Opportunity/Affirmative Action Employer
- Decisions made without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class
- Proud Veteran friendly employer
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