Job Title: Medical Coder
Duration: 6 months Contract (Possibility to extend or convert to FTE)
Location: Remote- CST
Shift Type: 8 am to 5 pm CST.
Pay range: $18 to 21 per hour
Job Duties:
• This role is unique for the typical Medical Coder because you are using your skill to evaluate if the provider billing follows correct coding guidance, other regulatory guidance, and policies to make a determination on whether the service is payable or not.
• Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion.
• Review medical records to ensure billing is consistent with medical record for appeals, adjustments and miscellaneous/unlisted code review.
• Review cases with Medical Director to validate decisions and identify opportunities to create medical policy in the absence of guidelines.
• Assist with research of health plan coding questions.
• Identify potential billing errors, abuse, and fraud.
• Identify opportunities to flag potential cases which may warrant a prepayment review (versus an automatic system denial or payment).
• Maintain appropriate records, files, documentation, etc.
• Individual will report for assignment by logging into the system remotely and start to work.
• They will work from a work queue that auto selects the next highest priority claim/med record review needed.
• They will record their productivity into our production tracking application.
Years of experience required:
• 2+ years of experience in medical billing & Coding.
• Analyze provider billing practices by utilizing code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA and CMS code edit criterion.
• Identify potential billing errors, abuse, and fraud.
• Operate technological hardware (laptop, pc) and work in software applications
Education/Certification Required:
• Associate’s degree in related field or equivalent experience.
• Coding Certification - CPC, CPC-H, CPC-A, CPC-P, CCS, CCS-P, CPMA, RHIT or RHIA
• Preferred: CPC, CPC-P, CCS, CCS-P
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