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Client Network Services LLC Associate Medical Claims Reviewer remote in Lansing, Michigan

font class="bold"Description/fontdivemSummary:/emThe role of the Associate Medical Claims Reviewer is to assist team members and clients with respect to billing, documentation policies, procedures, regulations, and requests for clarification of inconsistent, debatable, or non-specific documentation. This role is a member of the Medical Claims Review team and reports directly to the Medical Claims Reviewer Manager or Operations Manager. spanemWorking remotely within the United States is acceptable for this position./em/spanemWhat You Will Do:/emulliFunction as an individual contributor and will work under direct supervision./liliAssist with auditing charts and adjudicating claims while ensuring that all regulations are met in a timely manner./liliAssist with reviewing claims prior to payment, resulting in initial determinations./liliAssist with audits of records to identify irregularities or fraud by providers./liliAssist to ensure that billing is conducted in accordance with Current Procedural Terminology (CPT) guidelines./liliAssist in the review of billing of services that were not provided, misrepresentations of services provided, and compliance with policies and procedures./liliEnsure optimal reimbursement while adhering to federal and state regulations and Medicaid policies./liliAssist with working with Provider Support on resolution of provider issues./liliAssist in reviewing, researching, investigating, and replying to inquiries concerning compliance, inappropriate coding, denials, and billable services./liliKeeps abreast of new statutory regulations and medical terminology.em/em/li/ulemWho You Are:/emulliYou must have a CPC or CPC-A certification./liliYou have knowledge in medical coding and billing procedures./liliYou can demonstrate basic technical knowledge of statutory regulations and medical terminology, basic knowledge of auditing concepts and principles and basic knowledge of medical coding systems, procedures, and documentation requirements./liliYou have domain knowledge of Medicare, Medicaid, or healthcare verticals./liliYou can show initiative, enthusiasm, creativity, and resourcefulness in handling assignments./liliYou can demonstrate flexibility in working under demands and needs of the project./liliYou can concentrate for extended periods of time and accomplish the given task with minimum oversight./liliYou have strong analytical and problem-solving skills and strong attention to detail; can work within multiple groups of employees, be willing to share time, knowledge and information with others./liliYou can understand business needs, to analyze processes, and to develop alternative solutions and are able to independently and effectively manage inpatient and outpatient claims./liliYou can analyze and resolve issues./li/ulemAbout Us:/emAt CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We're passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability and fun! You will be offered a competitive compensation and benefits package. CNSI is

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