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Associate, CPC Outpatient Auditor
Schenectady, NY
Job Description
Associate, CPC Outpatient Auditor
Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America Fishkill Office, 300 Westage Business Center Drive, Fishkill, New York, United States of America Headquarters Office, 625 State Street, Schenectady, New York, United States of America Rochester Office, 220 Alexander Street, Rochester, New York, United States of America Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America Virtual Req #1164
Thursday, June 23, 2022
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!
Status: Full-time, Non-Exempt
Position can be remote/virtual within New York State or Vermont.
Summary:
Analyzes and provides coding review with recommendations for processing and payment of outpatient and surgical claims rendered by participating and non-participating physicians. Reviews claim modifiers and responds to correspondence and telephone calls from physicians and/or their staff. Processes multiple levels of appeals for all of the medical staff. Assists with the development and refinement of policies and procedures associated with physician services including: emergency care, office based services, surgery, and services referred to an outside lab/facility. Implements coding guidelines through coding software. Functions as a primary resource liaison with other MVP departments affected by coding criteria. Assists in the development and analysis of reports used to profile physician activity and develops outpatient care management protocols. Maintains a current and comprehensive knowledge of MVP policy and benefit language, and interprets policy as needed. Performs other duties as assigned.
POSITION QUALIFICATIONS
Minimum Education:
AAS degree or equivalent education and experience required.
CPC certification is required or must be obtained within 1 year of service.
CPC-P preferred
Minimum Experience:
Minimum of 2 years of claims work experience in insurance or medical coding is required.
Experience in outpatient claims processing and automated systems;
Required Skills:
Demonstrated ability to work closely with physicians, and corporate departments;
Strong analytical skills required;
Experience in working with claims coding software preferred;
Excellent verbal and written communication and interpersonal skills;
Excellent and efficient computer/data entry skills required
About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
Please apply and learn more - including how you may become a proud member of our team.
Other details
Apply Now
Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America
Thursday, June 23, 2022
Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it's time to make a healthy career move to MVP!
Status: Full-time, Non-Exempt
Position can be remote/virtual within New York State or Vermont.
Summary:
Analyzes and provides coding review with recommendations for processing and payment of outpatient and surgical claims rendered by participating and non-participating physicians. Reviews claim modifiers and responds to correspondence and telephone calls from physicians and/or their staff. Processes multiple levels of appeals for all of the medical staff. Assists with the development and refinement of policies and procedures associated with physician services including: emergency care, office based services, surgery, and services referred to an outside lab/facility. Implements coding guidelines through coding software. Functions as a primary resource liaison with other MVP departments affected by coding criteria. Assists in the development and analysis of reports used to profile physician activity and develops outpatient care management protocols. Maintains a current and comprehensive knowledge of MVP policy and benefit language, and interprets policy as needed. Performs other duties as assigned.
POSITION QUALIFICATIONS
Minimum Education:
AAS degree or equivalent education and experience required.
CPC certification is required or must be obtained within 1 year of service.
CPC-P preferred
Minimum Experience:
Minimum of 2 years of claims work experience in insurance or medical coding is required.
Experience in outpatient claims processing and automated systems;
Required Skills:
About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com
Please apply and learn more - including how you may become a proud member of our team.
Other details
- Job Family Medical Management/Clinical
- Pay Type Hourly
Apply Now
- Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America
- Fishkill Office, 300 Westage Business Center Drive, Fishkill, New York, United States of America
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York, United States of America
- Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America
- Virtual
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Associate Degree
Required Experience
1+ years
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