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Claims Coding Specialist
at Meridian
Detroit, MI

Claims Coding Specialist
at Meridian
Detroit, MI

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Description

Overview

Who we are:

 

Meridian, a WellCare Company, is part of a national network of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.


We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in Michigan, Illinois, Indiana, and Ohio. As a part of the WellCare Family of companies, we deliver healthcare excellence to millions of members nationwide.


Our associates work hard, play hard, and give back. Meridian associates enjoy an exceptional experience and culture including special events, company sports teams, potlucks, Bagel Fridays, and volunteer opportunities.

 

A Day in the Life of a Claims Coding Specialist:

 

Position is primarily responsible for reviewing, researching, and responding to written and emailed correspondence from providers, both professional and institutional, regarding claim denials based on clinical coding policies. Acts as a subject matter expert and handles more complex provider issues.

Responsibilities

  • Reviews and responds to written provider disputes, clearly and articulately outlining the payment discrepancy to the provider.
  • Thoroughly researches post payment claims and takes appropriate action to resolve identified issues within turnaround time requirements and quality standards.
  • Navigate CMS and State specific websites, as well as AMA guidelines, and compare to current payment policy configuration in order to resolve the providers payment discrepancy.
  • Review medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim adjustment is necessary.
  • Processes claim adjustment requests in Xcelys following all established adjustment and claim processing guidelines.
  • Utilize SharePoint and Excel as necessary to work through daily inventory assignments.
  • Identifies and escalates root cause issues to supervisor for escalated review.
  • Reviews and responds to internal escalated provider disputes transferred by management and other associates.
  • Acts as liaison with other departments when additional clarification is needed about claims payment policy disputes.
  • Assists team members with training opportunities and coaching.

Qualifications

What you can bring to Meridian:

  • High School or GED is required
  • 3+ years of experience in claim coding, claim processing or billing in a healthcare environment is required
  • 1+ year of experience in claims coding is preferred
  • CPC, CSS or relevant certifications Preferred
  • Strong knowledge of electronic medical records/billing systems and medical terminology and abbreviations is required
  • Intermediate billing expertise in UB92, UB04, HCFA 1500 and/or other healthcare services is required

What Meridian can offer you:

  • Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
  • Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
  • Meridian offers 401k matching that is above the national average.
  • Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
  • Meridian is an Equal Opportunity Employer

#MSTR

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