Dane Street
No Surprises Act IDRE Billing & Coding Specialist
Dane Street, Washington, District of Columbia, us, 20022
Overview
We are seeking a
No Surprises Act IDRE Billing & Coding Specialist
with experience exclusively in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. Candidates must have a deep understanding of IDRE processes and compliance requirements. Dane Street offers an exciting work environment, competitive compensation, and strong growth potential. Job Summary
A new program offering on the group health side of our business enables you to apply your clinical knowledge to review reports accompanying medical records to ensure that medical billing information and coding are correct. You will communicate with other reviewers and their office teams to ensure clarity of information and that all questions posed have been addressed, and ensure that reports are returned within client deadlines. Core Duties & Responsibilities
Evaluate the appropriateness of codes and determine whether they meet all established program standards. Ensure that medical records are matched appropriately to the codes and obtain records if not. Read and apply policy guidelines and healthcare terminology to delineate when criteria are/are not met. Evaluate claims for conflict of interest and criterion appropriateness. Work within established timeframes set by program parameters. Provide strong customer service skills and collaborate with clients on a case-by-case basis to provide complete, timely, and error-free quality assurance of cases. Provide clinical oversight to complex cases requiring additional review prior to return to the client. Serve as an additional level of QA and clinical knowledge/review for cases with quality issues. Requirements
Education & Experience: Must have a CPC, APCC, or DRG coder certification Payment integrity or professional bill review experience is strongly preferred Out-of-network bill review experience is a plus Experience working in a remote environment is preferred Experience in a medical office or health care background Skills: Must work with a sense of urgency and meet deadlines Must be self-motivated, with a strong drive for performance excellence Excellent written and verbal communication skills Proficiency in navigating a variety of computer programs (e.g., Google Chrome, Gmail, Docs, Sheets) is a plus Attention to detail PLEASE BE AWARE: Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment for security reasons. Benefits
We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you are an outstanding candidate for this position and thrive in a fast-paced environment, we encourage you to apply. About Dane Street
A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street processes over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process. Seniority level
Entry level Employment type
Full-time Job function
Accounting/Auditing and Finance Industries
Insurance
#J-18808-Ljbffr
We are seeking a
No Surprises Act IDRE Billing & Coding Specialist
with experience exclusively in Independent Dispute Resolution (IDRE) cases under the No Surprises Act. Candidates must have a deep understanding of IDRE processes and compliance requirements. Dane Street offers an exciting work environment, competitive compensation, and strong growth potential. Job Summary
A new program offering on the group health side of our business enables you to apply your clinical knowledge to review reports accompanying medical records to ensure that medical billing information and coding are correct. You will communicate with other reviewers and their office teams to ensure clarity of information and that all questions posed have been addressed, and ensure that reports are returned within client deadlines. Core Duties & Responsibilities
Evaluate the appropriateness of codes and determine whether they meet all established program standards. Ensure that medical records are matched appropriately to the codes and obtain records if not. Read and apply policy guidelines and healthcare terminology to delineate when criteria are/are not met. Evaluate claims for conflict of interest and criterion appropriateness. Work within established timeframes set by program parameters. Provide strong customer service skills and collaborate with clients on a case-by-case basis to provide complete, timely, and error-free quality assurance of cases. Provide clinical oversight to complex cases requiring additional review prior to return to the client. Serve as an additional level of QA and clinical knowledge/review for cases with quality issues. Requirements
Education & Experience: Must have a CPC, APCC, or DRG coder certification Payment integrity or professional bill review experience is strongly preferred Out-of-network bill review experience is a plus Experience working in a remote environment is preferred Experience in a medical office or health care background Skills: Must work with a sense of urgency and meet deadlines Must be self-motivated, with a strong drive for performance excellence Excellent written and verbal communication skills Proficiency in navigating a variety of computer programs (e.g., Google Chrome, Gmail, Docs, Sheets) is a plus Attention to detail PLEASE BE AWARE: Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment for security reasons. Benefits
We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you are an outstanding candidate for this position and thrive in a fast-paced environment, we encourage you to apply. About Dane Street
A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street processes over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process. Seniority level
Entry level Employment type
Full-time Job function
Accounting/Auditing and Finance Industries
Insurance
#J-18808-Ljbffr