Job Summary

This position responds to and resolves advanced to complex level issues related to the daily administration and operation of potential and existing providers and may involve provider education, interpreting and developing policies, procedures and guidelines. Provides in-service to appropriate personnel in regard to changes and updates in system support files.

Essential Functions

Minimum Qualifications

Must possess a strong knowledge of healthcare as normally obtained through the completion of a bachelors degree in business, healthcare administration, or related field.

Must have an excellent understanding of medical terminology and knowledge of CPT-4 and ICD-9 coding.

Must know how or learn to program data retrieval utilities and queries. The incumbent must possess the ability to track and analyze statistical data. This position requires a mathematical aptitude, computer experience, typing skills and the ability to work on a variety of projects in an organized fashion.Must have the ability to effectively communicate both verbally and in writing.

Preferred Qualifications

Three years of experience in the healthcare field preferred. Two years of medical claims auditing experience is preferable.

Additional related education and/or experience preferred.