Opportunity for a team player who understands medical terminology, coding, charge entry, insurance adjudication and collections. Must be organized and preferably possess CPC certification and/or other coding credentials/clinical expertise. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail, who enjoys working in a collaborative and team-based environment.
- Conduct ongoing retrospective documentation, coding and billing reviews to identify opportunities for revenue capture as well as potential compliance risks.
- Apply knowledge of Official Coding Guidelines for ICD-10-CM and ICD-10-PCS, Coding Clinic and CPT Assistant to various coding situations.
- Assist with governmental or third-party payer denials by evaluating compliance with coding guidelines, LCD’s, NCD’s and any applicable CMS or managed care payer guidelines.
- Evaluate claim edits for coding and billing deficiencies, reprocessing when necessary.
- Prepare accurate and thorough work papers, with complete documentation to support findings.
- Bachelor’s degree preferred.
- Minimum of 5+ years of auditing/coding experience with CPT, ICD-10, HCPCS and Modifier Coding.
- Knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of services and diagnoses.
- Working knowledge of billing guidelines, payer reimbursement policies, medical necessity criteria, and applicable industry based standards.
- Certified Procedural Coder (CPC) or Certified Outpatient Coding (COC), formerly CPC-H by the American Academy of Procedural Coders, or Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA)
- Proficient in Microsoft Office Suite including Word, Excel and e-mail application.
- Ability to communicate effectively with managers, clients and team members.
- Demonstrates independent judgment, discretion, and decision-making abilities.