Certified Medical Coder

Randstad USA; Boston (MA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Benefits package including health and

401K plan

Accommodation to accommodate disabled

Job summary

Randstad USA is seeking a Program Integrity Coder- FWA Auditor to verify itemized claim reviews for payment, coding, and billing guidance. The role involves working with SIU Investigators, analyzing medical records, and abstracting codes.

You will maintain current coding knowledge and provide SME support while ensuring Privacy and Security standards are met. Applicants should have 1–2 years of experience in medical record auditing, and hold an active certified coder credential.

Qualifications

• 1-2 years’ experience reviewing and auditing medical records.
• Active Certified coder credential and ability to maintain it.
• Knowledge of anatomy, medical terminology, and billing.
• Ability to interpret ICD-10-CM/PCS, HCPCS/CPT.
• Familiarity with DRG grouping systems and Plan designs.

Responsibilities

• Work with SIU Investigators assisting in research to make coding determinations.
• Analyze and interpret patient records for FWA investigations.
• Compare claim information to determine billable services.
• Determine appropriateness of billing and reimbursement.
• Document findings for each claim line in a spreadsheet.
• Summarize findings in a written report.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from records.
• Maintain knowledge of coding guidelines and regulations.
• Provide SME support to clients and ensure privacy compliance.
• Other duties as needed.

Skills

Anatomy & billing

ICD-10-CM/PCS

HCPCS/CPT

DRG coding

MS-DRG

Communication

Detail oriented

MS Office

EMR systems

Encoders

Education

Certified coder credential (RHIA, RHIT, CPC, CPMA, CIC, COC or CCS-P)

Tools

Encoders

EMR systems

Job description

The Program Integrity Coder- FWA Auditor is responsible for verifying the accuracy of itemized, complex claim review for payment, coding, and billing guidelines in accordance with the Plans’ provider agreements and the National Healthcare Billing Audit guidelines. The successful candidate must be capable of building and maintaining strong working relationships with key internal and external constituents and working effectively in a matrixed environment.

Responsibilities include:

Work with SIU Investigators assisting in research, discuss to make appropriate coding determinations as needed

Analyze and interpret patient medical records (behavioral related and other specialties) pertaining to FWA investigations as needed

Compare information submitted on the claims to determine amount and nature of billable services as needed

Determines appropriateness of billing and reimbursement as needed

Documents findings for each claim line in a spreadsheet as needed

Summarize findings in a written report as needed

Abstracts CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from medical records as needed

Responsible for maintaining current knowledge of coding guidelines and relevant federal and/or state regulations as needed

Provide Subject Matter Expertise and SIU support to clients as needed

Comply with Privacy and Security standards

Understands and complies with all company Privacy and Security standards

Other duties as needed

KNOWLEDGE, SKILLS, & ABILITIES

Knowledge of anatomy, medical terminology, and billing

In-depth knowledge of and ability to interpret ICD-10-CM/PCS, HCPCS/CPT,

Knowledge of APR-DRG, MS-DRG codes and DRG grouping systems and Plan benefit designs.

1-2 years’ experience reviewing and auditing medical records, working in a health plan or health insurance, or similar environment.

Ability to identify and abstract information from medical records (paper or electronic) to ensure coding guidelines are met

Knowledge of specialty medical practices

Must be detail oriented

Ability to communicate effectively both verbally and in writing

Responsible

Ability to meet defined performance and production goals

Strong computer skills: – proficient in MS Word, Excel, PowerPoint and Outlook, familiarity with Electronic Medical Record systems and Encoders.

Consistently meets coding quality standards and thresholds

CERTIFICATE/LICENSE

Active Certified coder (RHIA, RHIT, CPC, CPMA, CIC, COC or CCS-P) required; candidate would need to maintain active certification.

Finishing Touches (Preferred):

Knowledge of Health Insurance, Managed Care, Benefit Design, Medicaid, Medicare Advantage and Federal Regulations.

Hands-on work with complex medical and billing information preferred

___________________

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [e-mail].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.