Cogitativo Manager of Coding Compliance will
advocate and support our team in providing data-fueled solutions that help our
clients improve the U.S. healthcare system. We expect the Manager of Coding
Compliance position to have significant experience with coding, posting of
physician and ancillary charges, charge capture, managed care claims payment
techniques, provider reimbursement mechanisms.
The Manager will assist in researching coding, billing guidelines and creation of documentation for Cogitativo’s payment anomaly models.
job duties and responsibilities include:
- In coordination with our data
science teams, assist in designing and
deployment of continuous improvement programs for Cogitativo’s payment
integrity service offering.
Assist in the development and
validation of the Claims Payment Integrity machine learning models. These
advanced computational models are responsible for the identification of claims
payment anomalies, resulting from aberrant provider billing practices, coding
errors, contract misinterpretations, and internal processing payment errors. The Manager will ensure all machine learning
models are compliant with legal and
statutory requirements, including Office of Insurance Regulation (OIR), Federal
Employee Program (FEP), Medicare, and Medicaid.
Develop and maintain a strong professional relationship with key
stakeholders and internal data science teams to ensure specific and appropriate
program consistency across lines of responsibility through the organization.
with creation of presentation of payment integrity information as
- Participate in
brainstorming sessions, finalization, and creation of presentation of client-specific solution recommendations.
medical record documentation to identify incorrect coded and billed services, procedures,
valid ICD-10-CM, HCPCS and CPT-4 codes (includes E/M) and modifiers
Minimum five years experience in the areas of Payment Integrity,
claims processing, provider audit is required
Bachelor’s degree in a health related field or quantitative
discipline is desired
Certification of coding expertise by either the
American Academy of Professional Coders or
American Health Information Management Association.
Extensive knowledge of
medical claim edits (NCCI, LCD, et al.)
Hands-on knowledge of physician and hospital
reimbursement methodologies including Medicare, Medicaid, and commercial coding practices is required
in communication: verbal, written, and interpersonal
exceptional organization skills and attention to detail