Remote Medical Billing & Coding QA Specialist

Calling all bill review professionals, CPC coders, AAPC, and DRG coders! Dane Street is looking for highly motivated Coders, bill reviewers, and payment integrity reviewers candidates to join our team. 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 ensure all questions posed have been addressed, and ensure that reports are returned within client deadlines. Core Duties & Responsibilities: Evaluates the appropriateness of codes and determine whether they meet all established program standards. Ensures that the medical records are matched appropriately to the codes and if not, obtains them. Read & apply policy guidelines and healthcare terminology and delineate when criteria are/are not met. Evaluates claims for conflict of interest and criteria appropriateness. Works within established timeframes set by program parameters. Provides strong customer service skills and works closely with clients on a case- by-case basis to provide complete, timely, and error-free quality assurance of cases. Provides clinical oversight to cases that are complex and need additional review prior to return to the client. Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues. Required Education & Experience: ● Must have a CPC, APCC, CMBS, 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. Required 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 are required. ● Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus). ● Attention to detail REQUIRED. PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment. Robust opportunity for supplemental income Schedule flexibility and predictable work hours-conduct reviews based on your schedule availability Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal A fast-paced, Inc. 500 Company with a high-performance culture, Dane Street is seeking insightful, astute forward-thinking professionals. We process 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. #J-18808-Ljbffr