Job Title: Medical Coding Specialist Client Location: Columbia, SC | 29203 Work environment: Remote with occational onsite Duration: 3 months assignment with possible conversion Shift Schedule: 25 flexible hours per week
Job Description: Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.
Key Responsibilities:
60% Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation.
25% Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
10% Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
5% Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.
Required Education: Associate Degree - Health Information Management, OR, Graduate of an Accredited School of Nursing, OR, successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC). Required Work Experience: 1 year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or, 2 years: 1 year clinical experience and 1 year in either DRG, APC, HIPPS, HCPCS, or RUG coding and validation. Required Licenses and Certificates: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) Required Software and Other Tools: Microsoft Office.
Preferred Education: Associate Degree- Nursing or Four year degree in Health Information Management. Preferred Work Experience: 2 years-medical coding experience.
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 26.00/hr.
