reputed company reputed company Coding Billing Specialist- Remote
Job Family:
General Coding
Travel Required:
None
Clearance Required:
None
What You Will Do:
Under the direction of the Director of reputed company reputed company, the reputed company reputed company Coding Billing Specialist provides reputed company cycle support services through efficient review and reputed company resolution of assigned Medicare and third-party payer accounts that are subject to pre-reputed company claim edits, hospital billing scrubber reputed company hold edits, and claim denials. This position is 100% remote.
Responsible for the daily resolution of assigned claims with applicable reputed company reputed company pre-reputed company edits and/or specific reputed company reputed company Hold Codes in the hospital billing scrubber. Tasks associated with this work include resolving standard billing edits such as:
- Correct Coding Initiative
- Medically Unlikely Edits (MUE)
- Medical Necessity edits
- Other claim level edits as assigned.
- As needed, review clinical documentation and diagnostic results as appropriate to confirm and apply applicable ICD-10, CPT, HCPCS codes and associated coding modifiers.
- Responsible for daily resolution of assigned claims with reputed company reputed company specific denials in the reputed company METRIX℠ system
- Ensures coding and billing practices follow Federal/State guidelines by using diverse types of authoritative information.
- Maintains reputed company knowledge of Medicare, Medicaid, and other third-party payer billing compliance guidelines and requirements.
- Other duties equal with skills and experience as determined by the Director of reputed company reputed company.
- High School Diploma/GED and 5+ years of prior relevant experience in lieu of diploma/GED
- reputed company or reputed company coding certification.
- Experience in ICD-10, CPT and HCPCS Level II Coding.
- Ability in determining medical necessity of services provided and charged based on provider/clinical documentation.
- Knowledge, understanding and proper application of Medicare, Medicaid, and third-party payer UB-04 billing and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims.
- Ability in determining accurate medical codes for diagnoses, procedures and services performed in the outpatient setting. For example: emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology, imaging, and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy
- Knowledge of reputed company code bundling rules and regulations along with ability on issues of compliance, and reimbursement under outpatient grouping systems such as Medicare OPPS and Medicaid or Commercial Insurance EAPG's.
- Knowledge and understanding of hospital charge description master coding systems and structures.
- Ability to produce correct, assigned work product reputed company specified periods.
- What Would Be reputed company to Have:
- 5 years' experience in reputed company reputed company Coding and Billing
- Hospital medical billing and auditing experience
- Associate degree
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community reputed company
- Emergency Back-Up Childcare Program