Indianapolis, Indiana
Clinical Reviewer Job Opening in Indianapolis, Indiana - GenTech Associates, Inc is a CPA and management consulting firm focused on the federal marketplace. We are headquartered in Indianapolis but we support federal agencies across the country. Our current team includes alumni from the largest consulting firms and government agencies providing solutions to clients such as Defense Finance and Accounting Service, US Navy, US Air Force, US Army, Dept. of Homeland Security, and several others.
We are growing quickly and are in need of a Clinical Reviewer for a local customer in the Indianapolis area.
The Clinical Reviewer will independently review/audit various claims and medical records relating to Medicaid engagements.
Essential Functions :
Utilize health care knowledge and experience to review medical records for various types of medical services for accuracy, completeness and consistency with professional standards and compliance with billing and coding requirements
Document and report findings of reviews and audits in accordance with professional standards and project protocols
Participate in on-site field examinations of Medicaid providers to review clinical documentation * Work closely with accounting staff and state client personnel on health care reimbursement and compliance-related issues, including recommending changes and improvements of policies to ensure provider compliance
Perform additional assignments relating to Medicaid reimbursement
Develop and maintain general knowledge of Medicaid statutes, regulations, provider billing manuals and other Medicaid policies
Interpret and analyze health care data
Successfully interact with accounting staff, state agency staff and providers in a professional manner, developing rapport and enhancing business relationships
Requirements:
Bachelor?s degree in health information management, health policy, nursing, or other related health care field required
Understanding of health care claims, Current Procedural Terminology (CPT), International Classification of Disease (ICD), Healthcare Common Procedure Coding System (HCPCS) code sets
Experience and knowledge of state and federal health care regulations * Knowledge of Medicaid reimbursement and coverage policies desired
Experience with managed care systems preferred
Proficient use of applicable technology, specifically Microsoft Office applications (Excel and Word)
Strong analytical and problem solving skills
Strong verbal and written communication skills
Ability to manage multiple deadlines and prioritize assignments
Ability to work in a team environment
Well organized with a high degree of accuracy and attention to detail
Must be able to travel based on client and business needs (approximately 10%; in state)
Job Type: Full-time
Required education:
Bachelor's
Required experience:
Clinical Review: 3 years
Required licenses or certifications:
REgister Health Ifomation Management (RHIA)
CCS or CCS-P,CCDS
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