Altegra Health leads the U.S. healthcare industry with business & technology solutions that improve health plan performance by aligning member health status, benefits & accurate reimbursement in the following areas: Risk Adjustment Reimbursement & Advisory Services Eligibility & Enrollment Quality Performance                                                                    In an age where attention to detail counts--providers, health plans & healthcare facilities trust our 1,100+ employees for comprehensive solutions that add value to their bottom line. www.AltegraHealth.com     Job Title:  Inpatient / Home Health Coding & Medical Necessity Reviewer   We have an immediate opportunity for full time Inpatient / Home Health Coding & Medical Necessity Reviewer to join our team for a client assignment that will last at least 8 months, starting 2/20/12. Medical Claim Reviewers will perform claim audit reviews for medical necessity, DRG, and clinical validation in both inpatient and outpatient settings.   This is a remote, full-time, opportunity that will begin on 2/20/12; You must be available for one week of onsite paid training at our office in Los Angeles, CA starting 2/20/12 after that, the position will be remote and you can work from home. The Medical Claims reviewer will be responsible for utilizing a secure remote connection to access all required systems. The reviewer will then validate each review case to insure that all codes are appropriate based on diagnosis and services performed and determine if the services are medically reasonable and necessary.   The ideal candidate will have a clinical credential (RN, LVN, or LPN) with a coding credential from AHIMA or AAPC coupled with 3+ years of experience as an auditor/reviewer. We need reviewers within these three specialty areas: Inpatient Facility, Home Health, and Professional E/M.     Requirements   3+ years prior audit experience of these claim types Active certification as an RN, LVN, LPN, RHIA, CCS, RHIT, CPC, CPC-H, or CCS-P Ability to work 35-40 hours a week Ability to train onsite in Los Angeles for 1 week Experience working with remote systems including Citrix, EMR/EHR, encoder, etc. In-depth knowledge of ICD-9, CPT, HCPCS, revenue codes, coding clinic, and medical terminology Knowledge of CMS rules and regulations This is a remote, full-time, opportunity that will begin on 2/20/12; You must be available for one week of onsite paid training at our office in Los Angeles, CA starting 2/20/12 after that, the position will be remote and you can work from home.