Sr Claims Auditor
The Senior Claims Auditor at Cohere Health plays a pivotal role within the Payment Integrity team, focusing on conducting comprehensive coding reviews for both outpatient and inpatient claims. This position ensures the accuracy of code assignments and reimbursement processes, directly contributing to the company's commitment to precise and efficient payment solutions. Cohere Health is a leader in clinical intelligence, leveraging AI-powered platforms to enhance payer-provider collaboration and streamline access to quality care.
Key responsibilities include performing detailed audits of professional and facility coding, encompassing outpatient, professional, and inpatient claims. The auditor will assess code assignments, validate DRG/reimbursement accuracy, and identify potential overpayments. Utilizing advanced DRG encoder tools, the role requires crafting clear and concise audit findings supported by current coding guidelines and regulations. Staying abreast of industry trends and compliance regulations is essential to maintain expert-level knowledge.
Candidates must possess 3-5 years of experience in claims auditing, with expert-level knowledge of ICD-10-CM/PCS coding guidelines. Holding a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credential is mandatory. A bachelor's degree is required, along with exceptional analytical skills, attention to detail, and proficiency in written and verbal English communication. Experience with coding ambulatory surgery clinic claims and hospital observation claims, including injection and infusion claims, is highly desirable.
Cohere Health offers a comprehensive benefits package, including medical, dental, vision, life, and disability insurance, as well as an Employee Assistance Program. The company provides a 401K retirement plan with company match, flexible spending and health savings accounts, flexible time off, and up to 14 weeks of paid parental leave. Additional perks include pet insurance and opportunities for professional development.
Joining Cohere Health means becoming part of a dynamic team dedicated to transforming healthcare through innovative technology and collaboration. The company fosters a supportive, growth-oriented environment that values diversity and continuous learning, offering ample opportunities for career advancement and personal development.