JOB SUMMARYThe Medical Claims Coding Auditor is responsible for the investigation of coding issues and recommendation for correction of the issue. Responsible for reviewing and making payment determinations on provider medical claims for Claim Check and iHealth appeals. This position will conduct root cause analysis and detail review of provider documents, medical records and applying medical rational. Uses Correct Coding Initiatives (CCI) and National Correct Coding Initiatives (NCCI) as a guide to uphold SWHP Policies.ESSENTIAL FUNCTIONS OF THE ROLEReview medical records and documentation of claims to provide rational for upholding or overturning denials.Partner with SWHP Medical Director to create efficient processes and resolve pote
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