Brandon Schabbel

Quality Assurance Coder HealthCare Support is actively seeking a Quality Assurance Coder to fill an opening in Phoenix, Arizona. Daily Responsibilities for Quality Assurance Coder

• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
• Collaborate with technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within designated service level agreements.
• Perform other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.
• Sun-Thurs or Tues-Sat / REMOTE
• 10:30am-7pm CST 11am-7:30pm CST 11:30am-8pm CST

Required Qualifications for Quality Assurance Coder

• 5 years of professional coding experience, with at least 3 years of HCC coding experience. Advanced knowledge of coding guidelines
• Certified Coding Specialist – Physician Based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coding (COC) credential
• HCC higher condition categories- Medicare advantage- needed for reimbursement for care

Preferred Qualifications for Quality Assurance Coder

• 5 years of Medicare Advantage health plan experience
• 5 years of experience with HEDIS measures and/or the CMS Star Program

Benefits for Quality Assurance Coder

• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (advocacy) Program

Pay Details: $30- $46/ Hour Interested in Being Considered? If you are interested in applying to this position, please click Apply Now for immediate consideration. For additional questions, you may contact us at [email protected]. Please include your phone number, Job Title, and location and our recruiters will reach out. Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.