[Remote] Coding and Compliance Auditor-Behavioral Health

Note: The job is a remote job and is open to candidates in USA. WellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Coding and Compliance Auditor-Behavioral Health performs complex reviews and adjustments of medical claims to ensure accuracy in claim payments, aligning with payment policies and regulatory requirements. Responsibilities • Performs operational and financial audits of provider claims to identify overpayments and inform resolution of root cause issues with system configuration, provider contracts, claims operations, provider billing accuracy, and other party liability processes • Adjusts claim payments and adjudicates claims following established recovery guidelines and job aides • Identifies potential recovery projects and reports findings to management • Achieves department production, quality requirements, and individual financial recovery goals • Participates in special projects and initiatives • Assists in developing/revising departmental policies and procedures • Attends and participates in team meetings • Mentors and coaches less experienced staff and new hires Skills • 5 + years of work experience in Behavioral Health claims processing and/or health insurance experience working at a Behavioral Health facility or practice. This also includes at least 3 years of work related to medical billing and coding • Intermediate to expert knowledge of medical terminology, CPT, ICD9, HCPCS coding is required • Ability to work within large datasets to identify errors, anomalies, and outliers • Works with a high level of accuracy, attention to detail, and with superb work quality • Strong oral and written communication skills; ability to interact effectively with both internal WellSense colleagues as well as with external constituents such as providers and suppliers • Intermediate Excel experience required as well as proficiency using other Microsoft Office products including Word, Outlook, and PowerPoint • Must be able to multi-task, prioritize projects and work well with deadlines • Claim audit experience, (Behavioral Health Claims experience desirable) • Prior Medicaid/Medicare exposure • Working knowledge of Facets • SQL training • CPC or CCS certification preferred • Successful completion of pre-employment background check Education Requirements • Bachelor’s Degree or equivalent combination of education, training and related experience required. Benefits • Full-time remote work • Competitive salaries • Excellent benefits Company Overview • A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire. It was founded in 1997, and is headquartered in Boston, Massachusetts, US, with a workforce of 1001-5000 employees. Its website is Apply tot his job Apply tot his job