Medical Coding Specialist

Role Overview

• 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 responds 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.

Requirements

• 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
• Must have 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 managements’ 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 time of hire and as they may change or be added from time to time.

Benefits

• Health insurance
• 401k
• Paid time off
• Flexible work arrangements