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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in medical terminology and coding, ensuring accurate CPT and ICD coding while managing case documentation and communications effectively. Capable of coordinating with clinical teams and external review companies to facilitate timely and accurate review processes.
Highest-signal resume keywords
Medical TerminologyCPT CodingICD CodingClaims Processing SoftwareOral And Written Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical CodingCPT CodingICD CodingClaims ProcessingBasic Mathematical SkillsDocument ManagementQuality ControlData EntryProblem SolvingOffice Equipment Operation
Soft Skills
Excellent Listening SkillsOrganizational SkillsAdaptabilityAttention To DetailTime Management
Tools & Technologies
Care Management PlatformWindowsMicrosoft Word
Industry Keywords
Health Insurance ConceptsPrivacy StandardsConfidentiality StandardsPeer-To-Peer RequestsReview Determinations
About the role
Key responsibilities & impact- Manage daily work assignments
- Assist with incoming faxes
- Coordinate receipt and entry of pretreatments and pre-certification requests
- Ensure accurate CPT and ICD coding
- Communicate with providers to obtain complete and accurate information
- Upload and monitor external reviews sent to external review companies
- Correspond with external review companies as necessary
- Perform quality controls on review responses
- Process review determinations accurately within required timeframes
- Coordinate with the clinical team
- Document accurately and promptly in the Care Management Platform
- Facilitate and schedule peer-to-peer requests
- Review member account accuracy and report issues
- Initiate Case Management referrals when appropriate
- Participate in team meetings and committees
- Receive and relay communications to appropriate parties
- Contribute to daily workflow through regular and punctual attendance
- Coordinate and collaborate in the medical review process
- Prepare courteous and prompt responses for referrals
Requirements
What you’ll need- High school graduation or GED required
- Medical terminology and medical coding experience preferred
- Excellent oral and written communication skills
- PC skills, including Windows and Word
- Ability to learn and adapt to claims processing software changes
- Knowledge of medical terminology and basic health insurance concepts
- Excellent listening skills
- Ability to organize and recall detailed information
- Ability to interpret benefit summaries, insurance documents, plan benefits, and regulations
- Ability to identify and correct errors
- Ability to comply with privacy and confidentiality standards
- Ability to work flexibly under pressure and meet deadlines
- Ability to analyze and solve problems and exercise good judgment
- Ability to operate typical office equipment
- Working knowledge of general office procedures
- Ability to meet deadlines for appeals and reviews
- Basic mathematical skills
Benefits
Comp & perks- Remote work option
- Home internet requirement: cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload
- Tobacco-free policy
- Reasonable accommodation support for the application process