Coding Claim Review Specialist (Inpatient and Outpatient)

CorroHealth

2d

About The Position

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: Claims Review Specialist ESSENTIAL 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. 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.

Requirements

• 5+ years of directly related experience
• Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I)
• CCS, COC or CPC certification required
• Medical Terminology and anatomy knowledge is required
• Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines.
• Strong Microsoft Excel, PowerPoint, Word and OneNote skills
• Must 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)
• Strong analytical capability, independent thinker and good decision-making skills
• Excellent written and verbal communication and presentation skills
• Strong computer and technology knowledge and skills
• Highly professional demeanor, great client satisfaction skills
• Maintain current certifications and accreditations (as applicable). Research new guidelines, data elements, payer specifications, etc

Nice To Haves

• Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment.

Responsibilities

• Become proficient in the use of the PARA Data Editor, our proprietary software
• Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation.
• Audit all aspects of claim including (but not limited to): Omitted or incorrect charges, Review OPPS and CAH charges and apply guidelines. CMS/Payer specific guidelines Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) Departmental review for inaccuracies, omitted data/documentation and charges NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, Units of services E/M Profee/Facility Documentation improvement.
• Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries.
• Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing.
• Participate in presentations to clients and prospective clients, typically over web meetings.
• Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services.
• Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant.
• Other duties may be assigned as necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed