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Role Description

The Medical Coding Specialist (Internally called a Coding Specialist) is responsible for creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types. Ensures reviews are completed with the highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards, and/or federal and state mandates.

Schedule for this role is: Monday - Friday 8am-5pm EST

• Receive and input client and examinee data in the system database.
• Sort and verify each claim.
• Process and review each claim and address all necessary modifications manually. Contact Client as needed.
• Perform quality assurance on every case prior to completion.
• Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
• Process client invoicing in accordance with the client’s fee schedule.
• Handle and respond promptly to incoming calls, emails, or faxes from clients requesting report status and/or information.
• Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
• Provide testimony in court as to the content of prepared reports, as required. Travel as necessary.
• Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards, and legal regulations.
• Perform quality assurance on various coding-related reviews.
• Perform other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Minimum one year medical billing experience; or equivalent combination of education and experience required.
• Must possess current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT, or RHIA. CPMA certification preferred.

Requirements

• Must have a full understanding of aspects of medical billing.
• Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used.
• Must be able to cross-reference different types of billings to ensure consistency in the review process.
• Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing, and CMS reimbursement guidelines.
• Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must have a full understanding of HIPAA regulations and compliance.
• Must be a qualified typist with a minimum of 35 W.P.M.
• Ability to follow instructions and respond to management’s directions accurately.
• Ability to work independently, prioritize work activities, and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at the time of hire and as they may change or be added from time to time.

Benefits

• Competitive benefits (medical, vision, dental)
• Paid time off
• 401k