Clinical Coding Specialist
4 days ago
We are looking for a skilled and experienced Health Claims Administrator to join our Claims Operations team. As a key member of this team, you will be responsible for reviewing medical claims and assigning appropriate International Classification of Diseases (ICD) codes in line with coding requirements.
This role involves active involvement in the development of the clinical coding team and attendance at relevant training courses and system updates as required. You will also be responsible for completing governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy.
As a successful candidate, you will hold an APA qualification (or higher) and have 1-3 years' experience in health insurance claims assessment and ICD-10-AM clinical coding. You will be customer-focused, motivated to make a difference, and committed to delivering high-quality results.
Responsibilities and Requirements:- Review medical claims and assign appropriate ICD-10 codes in line with coding requirements.
- Ensure technical accuracy of coding completed in line with ICD-10 and responsible for timely quality data.
- Active involvement in the development of clinical coding team and attend any relevant training courses and system updates as required.
- Complete governance audits for all processed Hospital and Member Claims in line with our Quality Assurance Strategy.
- Act as the first line of defence and identify any potential areas of inappropriate billing, fraud and abuse of the hospital and member claims process.
- Actively manage all team mailboxes in line with agreed KPIs.
- Identify and report on any ineffective or inefficient controls or claims processes, and provide inputs and recommendations into the correction of issues identified to Senior Management.
Irish Life Group Services Limited is one of Ireland's leading financial services groups with over 1.5 million customers. For over 80 years, we've been helping people to look after their life insurance, pension, and investment needs, and more recently their health insurance.
We are proud of our culture of developing and supporting the growth and professional development of our people. The focus has resulted in a team of top talent with high standards, positioning us at the forefront of our industry.
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