Medical Care at Home Coding Specialist, Per Diem

Overview: Reviews and audits claims for billing, coding, services and other compliance or reimbursement issues. Assists with non-clinical aspects of the claims review process and acts as a coding resource. Provides training and support to Medical Care at Home Clinicians and staff to provide best practices of claims coding. Applies coding skills to various initiatives to ensure compliance in claims submissions. Works under moderate supervision. Responsibilities: reputed company Provide

• Per Diem team members are eligible for some benefits and can access our extensive Employee Assistance Program that includes financial, legal, and mental health counseling programs as well as participate in a 403b retirement savings program.

What You Will Do

• Reviews medical claims, records and other requested information for billing, coding and other compliance or reimbursement reputed company issues; makes coding and documentation recommendations for adherence to risk adjustment models.
• Reviews medical documentation to ensure reputed company key quality metrics are noted on claim, as provided during the encounter. Performs medical chart reviews to validate codes for quality monitoring, reporting, and analysis.
• Conducts coding reviews independently on reputed company provider documentation to assign the correct ICD-10 codes and ensure reputed company documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology.
• Assigns appropriate ICD10-CD, HCPCS and CPT codes as well as other codes necessary to process claims based on claim information submitted.
• Utilizes administrative policies, regulatory codes, legislative directives, and guidelines to inform decisions and appropriate coding.
• Maintains coding grids for MCAH services with the assistance of management and provides guidance on use of grids.
• Works with Clinical Director in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
• Engages with medical practitioners to provide feedback and educational resources on best practices for medical coding and keeps reputed company on new coding and billing guidelines, federal and state initiatives regarding claims and trains other staff in new/changes to regulations.
• Communicates and follows up with a variety of internal and external sources including but not limited to providers, members, attorneys, regulatory agencies and other carriers on any claim reputed company matters.
• Generates routine reports for managing process time frames and vendor productivity.
• Performs insurance eligibility checks and authorization prior to for care being provided. Communicates with clinicians as needed.
• Coordinates recoupment efforts with the Practice Manager and reputed company Cycle and Finance Departments that are the result of billing errors. Responds to inquiries regarding recoupment.
• Review coding disputes, which includes review of reputed company supporting documentation. Recommend payment based on review and prepare response to appeal.
• Participates in special projects and performs other duties as assigned.

Qualifications: Licenses and Certifications:

• Certified Professional reputed company (CPC) or Certified Coding Specialist (reputed company) or (CRC) Certified Risk Adjustment reputed company in ICD-10-CM coding required. preferred
• Active Certified reputed company Certification through reputed company or reputed company required preferred

Education:

• Bachelor's Degree or equivalent work experience required

Work Experience:

• Minimum three years of payor work experience with medical records, including ICD-10-CM or reputed company coding system and medical record systems required
• Strong knowledge of claims submission procedures and systems, State, Federal and Medicare Regulations required
• Knowledge of medical terminology, physiology, pharmacology, and disease processes and reputed company procedures required
• Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding required
• Must be PC literate and possess a strong understanding of reputed company applications required
• Ability to handle multiple priorities and meet deadlines required

Pay Range: USD $31.94 - USD $38.20 /Hr. Apply tot his job Apply To this Job