Coder, Special Investigations Unit, MI - Remote

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About the position

We are looking for a SIU Coder, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives. McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members. McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at Position Overview: The Special Investigations Unit (SIU) Coder supports lines of business from McLaren Health Plan, Inc., McLaren Health Plan Community, and McLaren Health Advantage (McLaren) and is responsible for performing medical claims and records reviews to assist in investigations, ensuring compliance with coding practices through a comprehensive record review for medical, behavioral, transportation and other healthcare providers. The SIU coder works in collaboration with a team of SIU Auditors to review records and claims as part of the ongoing audits of the SIU department. The SIU coder serves as the subject matter expert for all coding activities and collaborates with other departments within McLaren on payment integrity and provider education. This position is fully remote.

Responsibilities

  • Perform medical claims and records reviews to assist in investigations.
  • Ensure compliance with coding practices through comprehensive record review for various healthcare providers.
  • Collaborate with a team of SIU Auditors to review records and claims.
  • Serve as the subject matter expert for all coding activities.
  • Collaborate with other departments on payment integrity and provider education.

Requirements

  • Associate's Degree in Health Information Management, Healthcare Business Services, or equivalent program with emphasis in coding or High School diploma with two (2) years of related experience.
  • Certified Medical Coder (CPC, RHIT, or RHIA).
  • Two (2) years of hands-on experience in ICD-10-CM and AMA diagnostic coding.
  • Two (2) years of coding experience on multiple specialties.

Nice-to-haves

  • Five (5) years coding and/or coding and billing experience.
  • Two (2) years' experience assisting with SIU audits.
  • Managed Care experience.
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