Medical Claims Review III

Responsible for the pre and post payment clinical claims review function. Ensures accurate adjudication by applying medical coding and billing guidelines, reimbursement methodologies and clinical knowledge. Member of the nurse coder team within the claim review continuum, between coders and medical directors. Responsible for individual quality and quantity of work, supportive of other team members, provides information to supervisor regarding process and potential improvements, works collaboratively with claims operations staff, medical directors, and policy developers.

Qualifications:

• Associate's or Bachelor's degree in Nursing, or equivalent experience in related field
• 5+ years of work experience in the Health Insurance industry (claims, coding, utilization management, etc.)

Required Licensure/Certification:

• LPN or RN license required
• Coding certification preferred ex. CPC-P, COC, RHIT, CCS

Skills and Abilities:

• Strong written and verbal communication skills
• Self-starter with the ability to work independently
• Proven ability to multi-task

This position is a Remote role and will work remotely 100% of the time. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

The full salary range for this position is $67,100 - $115,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.