Medical Review Claims Analyst II; Fully Remote

• Maintain workflow balance to ensure re-pricing requests are accurately completed within departmental time frames.
• Apply working knowledge of medical terminology and coding principles in re-pricing claims and complete assignments meeting quality assurance goals.
• Implement, terminate, and track pre-pay edit requests daily, and prepare monthly prepay saving reports.

• Extensive knowledge of medical terminology and coding principles, plus knowledge of Medicare guidelines and coverage.
• Ability to read Medicare/Medicaid claims, both paper and electronic, with working knowledge of Medicare claims pricing and payment systems.
• High school diploma required; two-year degree with healthcare emphasis and CPC certification preferred.
• Medical, Dental, and Vision plans.
• Life, LTD, and STD paid by the employer, plus 401(k) with company match up to 4%.
• Paid Time Off, company paid holidays, and tuition assistance after one year of service.

Covent Bridge Integrity Systems is a national leader in the fight against healthcare fraud, waste, and abuse, providing investigative services, technology, and expertise to government and commercial healthcare payers. They are an equal opportunity employer committed to inclusion, diversity, and supporting employees with benefits and accommodations.