Job Type: Contract

Job Category: IT

Job Description

 Certified Medical Coders

Location: Remote (need to Travel in the Tampa Bay, FL or Atlanta Metro, GA)

Job Descriptions:-

• Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.
• Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.
• Coordinates research and responds to system inquiries and appeals.
• Conducts research of system edits and make determination on claim decision on the provider dispute.
• Experience in working in various claims systems (i.e Facets, Encoder Pro, etc)
• Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.

QUALIFICATIONS:

• Certified & active Professional Coder. AAPC (CPC, CEMC, COC, CIC) or AHIMA (CCS, CCS-P)
• Experience with appeals and denials (NCD/LCD, Duplicate, MUE)
• 2 years of prior experience as a coder with E&M and surgical coding
• Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.
• Minimum 3 years’ experience reviewing denied claims and performing coding audits in a healthcare or insurance environment.
• Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.
• Ability to interpret medical records and apply coding principles accurately.
• Facility coding experience preferred

• Multiple specialty coding experience preferred experience in payor insurance processes
• Experience in payor insurance processes preferred

Required Skills