Medical Coder Salary in Phoenix, AZ

Job Summary We offer remote work opportunities (AK, AR, AZ, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE,NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, WI & WY only) Supervises Diagnosis-Related Group (DRG) validation process and coding staff to ensure contractual compliance. Reports to the Manager, Retrospective UM. Supervises staff who conduct retrospective review of medical claims for appropriate DRG or non-DR coding and processing. Performs independent research and in-depth evaluation of complex medical claims. Ensures that provider documentation conforms to legal and procedural requirements. Represents TriWest as DRG coding Subject Matter Expert on work groups. The Supervisor also oversees the UM specialist staff functions, including requesting, receiving, processing, filing, and maintaining all medical records required for review. Determines work assignments, audits accuracy of work products, and is responsible for the timeliness of work completion for all assigned staff. Responsible for ensuring accuracy and currency of area related policies and procedures. **Veterans, Reservists, Guardsmen, and military family members are encouraged to apply** Education & ExperienceRequired: • Bachelor's degree or equivalent combination of education and experience Current Certification as: Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) • 2+ years of clinical experience • 2+ years coding experience • 2+ years processing medical claims • 2+ years of UM experience utilizing commercially developed UM criteria • 2+ years supervisory/management experience Preferred: • Managed Care experience • Familiarity with TRICARE and military health care delivery system Key Responsibilities• Supervises retrospective coding validation reviews of medical claims and associated reporting processes. • Supervises staff processes for requesting, obtaining, filing, and managing medical records. • Utilizes management reports to support DRG validation and medical record processes. • Coordinates coding matrix validation, program sets, profile structure and maintenance, and routine updates for coding and policy changes due to profiles. • Assists staff with the application of complex coding conventions to appropriately code and sequence medical claims for claims payment and DRG validation purposes. • Stays current with updated coding information and changes in coding regulations and practices. • Serves as Subject Matter Expert for coding issues, including implementation of new codes. • Develops materials and trains assigned staff on coding guidelines, compliance issues, and coding policy changes, medical record process changes as appropriate. • Coaches/mentors staff on performance standards, employee issues and concerns.• Interprets relevant sections of the TRICARE Operations Manual, TRICARE Policy Manual, and TRICARE • Reimbursement Manual to perform functions. • Performs focused audits to ensure compliance with coding requirements and medical record maintenance and confidentiality. • Interacts with internal and external entities on resolving customer services issues to ensure customer service needs are met. • Other duties as assigned. • Regular and reliable attendance is required. CompetenciesCommunication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Proficient with Microsoft Word, Excel, PowerPoint, Outlook, Visio & Access; Knowledge of managed care principles and methods; Knowledge of auditing and analysis principles; Knowledge in the application of ICD-10-CM, DSM, CPT, and HCPCs and American Dental codes; Working knowledge of medical management system, including report compilation; Knowledge in health information management (HIMs) processes and retention requirements. Working ConditionsWorking Conditions: • Availability to work any shift • Works remotely, with up to 10% travel • Ability to meet mandatory contract compliance timelines • Extensive computer work with prolonged sittingCompany Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Generous paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!! We offer remote work opportunities (AK, AR, AZ, *CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)Job Summary The Coding & Reimbursement Analyst supports claims payment accuracy and waste reduction initiatives by collecting, aggregating, and analyzing claims data from multiple systems. This role requires documenting, reporting, and communicating information, as well as performing claims data analysis to mitigate risks while identifying patterns and trends. The Coding & Reimbursement Analyst has a strong understanding of claims coding and payment methodologies as well as data analytics. This position is responsible for turning claims adjudication and provider billing data into meaningful information, which Claims Admin leadership will use to make informed decisions to improve claims quality, efficiency, and Government contract(s) adherence.Education & Experience Required • Bachelor's degree in Business Administration, Finance, Healthcare, Information Management or equivalent experience • 3 years' experience in healthcare analysis, data management or equivalent • 3 years' experience in a claims environment, with a strong knowledge of CMS coding and reimbursement methodologies • Proficient in Microsoft Office suite, with an emphasis in Excel and data analysis and reporting Preferred • Quality or Process Improvement experience • Experience with data visualization tools such as Tableau, Power BI, etc. • Working knowledge of structured query language (SQL), and SQL Reporting Services (SRS) • Government claims experience • Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)Key Responsibilities • Acquires claims data from primary or secondary data sources. • Identifies, analyzes, and interprets trends or patterns in complex claims data sets. • Develops visualizations and presentations to summarize and explain claims data findings or quality issues. • Evaluates the completeness and accuracy of claims data. • Works closely with Claims Admin leadership and SMEs on process and quality improvement strategies and/or provider education efforts, resulting from claims data analyses and findings. • Must have strong problem-solving and decision-making skills. • Ability to define problems, collect claims data, establish facts, analyze claims data, and report the findings to appropriate stakeholders. • Ability to collect, aggregate and disseminate data in understandable, digestible, and useful ways across the organization. • Will effectively present claims data information and respond to detailed claims payment or coding questions from varied internal or external groups.Competencies Technical Skills Advanced analytical skills; knowledge of fundamentals of accounting and sound business processes; extensive knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred; research and project management skills. Team-Building / Team Player Influence the actions and opinions of others in a positive direction and build group commitment. Problem Solving / Analysis Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues. Organizational Skills Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Information Management Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions. High Intensity Environment Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Coping / Flexibility Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach. Computer Literacy Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Communication / People Skills Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.Working Conditions • Favorable working conditions in a climate controlled office space • May work within an office environmentCompany Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Generous paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time *Annual base salary for Colorado and Washington State residents: $95,000 - $102,000 depending on experience*Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)Job Summary Reviews medical documentation to determine correct coding on submitted medical and behavioral health claims utilizing appropriate clinical staff resources as needed to assist in review. Update authorizations as necessary with appropriate codes.Education & Experience Required: • High school diploma or G.E.D. • 1+ years claims review experience • Medical terminology knowledge • 1+ years working with medical documentation Preferred: • Claim coding experience • Knowledge of Behavioral health claims review • Certified Processional Coder (CPC)Key Responsibilities Conducts medical documentation review to determine appropriateness of coding of service o Validates medical determinations through research of resources including regulatory manuals, computer files and documentation. o Assists in preparation of cases for program payment or medical director review as indicated. o Validates all appropriate data is supplied with program invoice. o Reviews Authorization data for process improvements o Ensures contract compliance for timelines regarding resolution of medical documentation review and updates o Communicates effectively with management and peers. o Consistently meets quotas for position o Identifies and reports any potential quality or fraud issues to management, Quality Management or Program Integrity as needed. o Provides support regarding clinical and coding questions. o Performs other duties as assigned. o Regular and reliable attendance is required.Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Find-a-Code, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract.Working Conditions Working Conditions: o Favorable working conditions in a climate controlled office space; must be available to cover any work shift; works within an office environment with minimal travel required; level II IT security clearance. o Extensive computer work with prolonged sitting. o Security clearance as required by contract.Company Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Generous paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time *Annual base salary for Colorado, Hawaii and Washington State residents: $46,000 - $51,000 depending on experience*Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

About UsIntegrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.At IntegrityM, we offer a culture of opportunity, recognition, collaboration, compassion and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees' professional development. Large company perks...Small company feel!We are now seeking a Medical Review Manager to join our team. This is a contingent position.RequirementsMinimum three (3) years' experience practicing nursing as a licensed Registered NurseMinimum of three (3) years' experience of supervisory/managerial experience in the health insurance industryBachelor's degree in Nursing is required. Registered Nurse LicensureCertified Professional Coder (CPC) Certification or the ability to obtain this certification or similar coding certification within 12 months of appointment

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, *WA, WI & WY only)Veterans, Reservists, Guardsmen and military family members are encouraged to apply!Job SummaryThis position is under the general guidance of the Manager, Program Integrity and reports directly to the Supervisor, PI Specialist. The PI Specialist is responsible for the identification, analysis, case developmThis position is under the general guidance of the Manager, Program Integrity and reports directly to the Supervisor, PI Specialist. The PI Specialist is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA) and the Healthcare Finance Administration (HCFA); requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s). Complies with the Veterans Affairs Community Care Network (CCN) contract, Defense Health Agency TRICARE contract, and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, TRICARE beneficiaries, providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals.ent, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA) and the Healthcare Finance Administration (HCFA); requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s). Complies with the Veterans Affairs Community Care Network (CCN) contract, Defense Health Agency TRICARE contract, and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, TRICARE beneficiaries, providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals.Education & ExperienceRequired o 2 years experience in fraud, waste and abuse investigations, or equivalent claim auditing experience o Experience with data analysis techniques, to include Excel and/or SQL expressions o High School Diploma or GED required o Experience with quality review standards and healthcare claims analysis techniques o Knowledge of medical billing regulations and practices, as well as standard healthcare benefits and exclusions Preferred o Knowledge of current trends in healthcare fraud, waste and abuse o Knowledge of CMS benefits and policies o Knowledge of Facets o Certified Coder (CPC, CPC-P, CCA, CCS-P), AHFI, or other related certification o Experience with IBM's Fraud and Abuse Management System (FAMS) and Case Manager Solutions o Experience with PeopleSoft and MS Office SuiteKey Responsibilitieso Independently researches FWA issues and effectively employs investigative resources/techniques in achieving projected PI performance goals and outcomes, requiring minimal direction o Maintains the confidentially and non-discoverability of all fraud and abuse, quality assurance, quality management, and risk management issues. o Reconciles special, unresolved issues associated with beneficiary and provider inquires o Facilitates and supports Program Integrity goals, objectives, and contract compliance o Readily accesses and interprets VA, TRICARE, and TriWest guidelines, policies and procedures o Effectively utilizes appropriate data systems as provided and required by TriWest to identify, research, document and track fraud and abuse issues and activities. o Participates in and/or completes VA or TRICARE directed leads, audits, investigations, data collection, and medical record reviews for fraud and abuse case development. o Proactively identifies and researches potential fraud and abuse issues o Performs as a witness in court as requested o Researches and investigates health care fraud issues, claims data, medical records as they relate to potential fraud and abuse cases (i.e.; problem provider issues) o Prepares and submits medical records for PI clinical review as appropriate o Ensures accuracy, completeness, and timely submission of all required leads, reports, audits, and case development activities and documents o Coordinates/liaises with TriWest departments, PGBA POC's, and government agencies in researching, determining, and reporting FWA issues. o Participates in and contributes to PI education and training for beneficiaries, providers, subcontractor, and TriWest interdepartmental personnel regarding fraud and abuse o Assists supervisor in the preparation and compilation of monthly, quarterly, semiannual, and special reports as required o Participates in system enhancements for reporting fraud and abuse activities o Facilitates the development of Program Integrity materials for staff, provider and beneficiary education and training as well as assist other departments with educational requests . o Facilitates the development of Program Integrity materials for provider seminars, provider newsletter, and quarterly bulletins o Assists in the development of quality studies as directed by TriWest Medical Directors o Assists supervisor with the annual review of PI policies and desk procedures o Demonstrates effective use of documentation systems for communication, tracking, trending, and reporting purposes o Research and prepare appropriate and timely responses to beneficiaries, provider and congressional compliant issues referred to Program Integrity by other company departments. o Interfaces with all levels of TriWest employees and maintains effective working relationships while adhering to all customer service goals and guidelines. o Demonstrates flexibility and adaptability towards achieving PI departmental performance/production goals and objectives o Routinely processes recoupment requests, live claims, and performs other duties as assigned. Attends and participates in continuous training opportunities in current schemes and trends related to FWA o Participates in and contributes to FWA information-sharing resources, task forces, and joint investigative efforts Regular and reliable attendance is required.CompetenciesTechnical Skills Knowledge with CPT4, ICD-10-CM, HCPCS, DRG and Revenue Code coding conventions. Knowledge of standard benefit coverage policies and exclusions, including National and Local Coverage Determinations. Knowledge of standard healthcare billing regulations and practices. Problem Solving / Analysis Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues. Organizational Skills Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.Working ConditionsWorking Conditions: • Availability to work any shift • This is a remote position, with minimal travel • Extensive computer work with prolonged sittingCompany Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.DoD StatementOur Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Generous paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time *Annual base salary for Colorado, Hawaii and Washington State residents: $58,000- 75,000 depending on experience*Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.