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Post-Pay Clinical Coding Specialist Job in Chicago, Illinois

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Job Title: Post-Pay Clinical Coding Specialist

Employer:AArete LLC
Skills:Medical claims billing,coding,compliance,reimbursement,Claims processing,auditing
Specialties:Medicare) and state (Medicaid) medical guidelines, Federal (CMS
Required Certifications:CPC
Preferred Certifications:CPC-P
Required Experience:5 to 7 years
Preferred Experience:8 to 10 years
Location:200 E Randolph St., Suite 3300 Chicago 60603, IL, US
Date Posted:5/23/2019

Post-Pay Clinical Coding Specialist

We’re passionate, we’re collaborative and we are growing.

At AArete we live and breathe to provide the best experience to our clients each and every day. We are fresh, passionate, have tons of energy, and love what we do – provide non- labor cost reduction solutions and wow our clients with impeccable service.

It is an exciting time to join the AArete team. Our phenomenal growth since 2008 means that the opportunity exists to expand your skill set and realize your career goals. Come join the company that was named to Crain’s Chicago “Fast Fifty” List 2018 and Consulting Magazine’s Best Small Firms to work for 2018.

Position Characteristics:

As Coding Specialist in the AArete Center of Excellence, you will work closely with client teams to demonstrate in-depth industry knowledge of medical billing, claims adjudication systems and payment policies. Ultimately, the Coding Manager is responsible for delivering medical claims clinical and coding recommendations and supporting the development of strategies for change.


Primary Responsibilities and Requirements:

·         Effectively act as a cross-functional partner between AArete’s Center of Data Excellence (CODE), business consulting/client delivery and data teams to deliver medical claims clinical and coding recommendations

·         Serve as a subject matter expert in medical billing, claims adjudication systems and payment policies

·         Review pricing discrepancy claims analytics generated through CODE’s advanced data analytics methods from a clinical and medical coding perspective

·         Accept/Reject clinical coding recommendations on claims through review of corporate policies, regulatory codes, legislative directives, provider contracts, pre-authorizations, medical records, precedent, practice standards or other guidelines, including Current Procedural Terminology (CPT) coding logic/rules

·         Quantify over-/under-paid claims based upon findings

·         Assist with identification and creation of preventative measures including educational materials, payment holds, new/changed payment policies, etc.

·         Identify billing issues that can be resolved through recalibration of the adjudication system or via claims editing

·         Assist in monitoring business processes/systems to assure integrity and compliance in billing and claims payment

·         Develop internal reports to identify potential over-/under-payments

·         Review high-dollar claim and post-payment review reports, medical records and itemized bills to identify issues and recommend changes

·         Serve as a mentor/coach for and manage the day-to-day activities of Post-Pay Analyst team

·         Develop relationships and work closely with business consulting and data teams

·         Research regulatory billing and coding questions

·         Maintain appropriate records, files, documentation, etc.



·         Minimum 5 years of medical claims processing and medical billing experience

·         Knowledge of:

o   Federal (CMS, Medicare) and state (Medicaid) medical guidelines is required

o   Medical claims billing, coding, compliance and reimbursement related issues

o   Claims processing, recovery and audit functions

·         CPC required, Payor background preferred

·         Proficiency with Microsoft Suite, including advanced Excel skills, PowerPoint and Word

·         Previous experience managing a cross functional team 

·         Previous experience working with third-party clients and/or vendors preferred

·         Deep knowledge and well-rounded understanding of the Healthcare Insurance Payer Industry, including familiarity with all of the following:

o   The configuration process (including Claims, Provider and Member) and the adjudication processes

o   All lines of business:  Medicaid, Medicare, Duals, Marketplace, Commercial, ASO (Administrative Services Only)

o   All spend areas:  Professional, Outpatient, Inpatient, Ancillary

·         Knowledge and understanding of Integrated Delivery System preferred

·         Consulting experience a plus


Caitlin Chuckta
Recruiting Sourcer

Or visit www.aarete.com/careers

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