Job Description
Job Description
The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth
reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
Essential Functions
• Provide Provider Pre Pay production and progress reports and coordinate with management
and team on recommendation for further actions and/or resolutions in order to increase team
performance
• Recommend process or procedure changes while building strong relationships with cross
departmental teams such as Claims, Configuration, Health Partners, and IT on identified
internal system gaps
• Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts to
identify and perform oversight and monitoring of claims decisions based on documentation
• Identify and assist in correction of organizational workflow and process inefficiencies
• Serve as the primary resource for provider pre-pay team
• Use concepts a...
The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth
reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
Essential Functions
• Provide Provider Pre Pay production and progress reports and coordinate with management
and team on recommendation for further actions and/or resolutions in order to increase team
performance
• Recommend process or procedure changes while building strong relationships with cross
departmental teams such as Claims, Configuration, Health Partners, and IT on identified
internal system gaps
• Demonstrate leadership ability, including mentoring Program Integrity Claims Analysts to
identify and perform oversight and monitoring of claims decisions based on documentation
• Identify and assist in correction of organizational workflow and process inefficiencies
• Serve as the primary resource for provider pre-pay team
• Use concepts a...