CPC Claims Reviewer
CareCore National - Bluffton, SC

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Objectives: The PSPP Claims Reviewer is a Certified Medical Coder/Claims Reviewer responsible for reviewing surgical claims as part of the Post Service Pre-Payment Program, focusing on services that were authorized, performed and billed for. The goal is to ensure that services billed were authorized and performed

CareCore National is an Equal Opportunity Employer M/F/D/V and Drug-Free Workplace

Minimally required qualifications:
Knowledge: • Advanced knowledge of medical coding, health claims reimbursement methodology and regulatory requirements
• Knowledge of claims auditing concepts and principles

Job Requirements:

• Certified Professional Coder (CPC) with the American Academy of Professional Coders
• Minimum 3-5 years of relevant experience, preferably with payer experience
• Experience with Medicare/Medicaid/Third Party payers is preferred
• Experience in coding claims, processing claims, auditing claims, investigating claims, or insurance assignment of codes in their claims processing system
• Utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-9-CM diagnoses and ICD-9-CM/CPT-4 procedures
• Ability to work independently in a fast-paced environment with accuracy

CareCore National - 7 months ago - save job - - block
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Since 1994, CareCore National has provided comprehensive, customized programs to health plan clients that seek to manage appropriate...