Claim Review Specialist - Coding Certification Required
About Us:Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY:Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned.Coding certification through AHIMA or AAPC required (we do not accept CPC-A)Must have extensive experience (5+ years) in OP facility coding to include ED, SDS, I&I, OBS, E/M for facility, etc. IP facility coding is plusCritical Access setting experience is a plusThis is a remote positionESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.Reports To: Director of HIM/Audit Services (RCM Services)Location: Remote USA; work from home officeFLSA Status: Full time, exemptQUALIFICATIONS5+ years of current directly related experienceExpert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I)CCS, COC or CPC certification requiredMedical Terminology and anatomy knowledge is requiredClinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines.Strong Microsoft Excel, PowerPoint, Word and OneNote skillsMust have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS and ICD-10 CM)Strong analytical capability, independent thinker and good decision-making skillsExcellent written and verbal communication and presentation skillsStrong computer and technology knowledge and skillsHighly professional demeanor, great client satisfaction skillsESSENTI...