APC Coding Validation Specialist

The Rawlings Group; Brasil; Híbrido; BRL 429.000 - 538.000; Tempo integral

Resumo da oferta

A healthcare analytics firm is seeking a professional for a remote coding position requiring strong analytical skills. Applicants should have a minimum of five years in outpatient coding and relevant certifications. This role offers competitive salary up to $100,000, health benefits, and opportunities for personal development.

Serviços

PTO and paid holidays

Health, vision, and dental coverage

401(k) plan participation with company match

Opportunity for career progression

Qualificações

• Minimum of five years of hospital outpatient coding for PPS reimbursement.
• Comprehensive knowledge of the APC structure and regulatory requirements.
• Experience performing APC validation.

Responsabilidades

• Perform comprehensive analysis of claim information.
• Maintain expert knowledge of CPT and HCPCS Level II coding.
• Analyze and resolve coding issues related to reimbursement.

Conhecimentos

Coding knowledge

Attention to detail

Communication skills

Formação académica

High School Diploma or Equivalent GED

National certification as Registered Health Information Administrator (RHIA)

National certification as Certified Procedural Coder (CPC)

Descrição da oferta de emprego

Overview

Employer Industry: Healthcare Intelligence

Why consider this job opportunity

• Salary up to $100,000
• PTO, paid holidays, and volunteer days
• Eligibility for health, vision, and dental coverage, along with 401(k) plan participation with company match
• Remote and hybrid work options available
• Opportunity for career progression and personal development within the organization

What to Expect (Job Responsibilities)

• Perform comprehensive analysis and review of claim information and associated medical records to validate the accuracy of billed procedure and service codes
• Maintain expert knowledge of CPT and HCPCS Level II coding conventions, Official Coding Guidelines, and ICD-10 diagnosis coding
• Analyze, review, and resolve coding issues related to reimbursement, compliance, and client-specific policies
• Validate patient data by comparing claims data with medical records
• Maintain accuracy, quality, and production standards set by management and clients

What is Required (Qualifications)

• High School Diploma or Equivalent GED
• National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Procedural Coder (CPC), and/or Certified Coding Specialist (CCS)
• Minimum of five years of hospital outpatient coding for PPS reimbursement or at least two years of experience performing APC validation
• Comprehensive knowledge of the APC structure and regulatory requirements
• Excellent oral and written communication skills

How to Stand Out (Preferred Qualifications)

• Associate or Bachelor's degree in health information management, medical coding, or a related field
• At least two years performing post-adjudication/pre-pay or post-payment APC validation
• Well-rounded APC experience, including specialty coding such as interventional radiology, infusions, and surgeries
• Experience coding or reviewing EAPG claims

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