Certified medical coder

Randstad; United States; Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Medical

Prescription

Dental

Vision

AD&D

Life insurance

Short-term disability

401K plan

Job summary

Randstad is seeking a 100% remote Program Integrity Coder - FWA Auditor for a 3-6 month contract. The role entails verifying the accuracy of itemized claim reviews, coding and billing guidance per provider agreements and national audit guidelines.

Requires active CPC/CPC-like certification and 2 years of related experience. Knowledge of ICD-10-CM/PCS, HCPCS/CPT, and DRG systems is essential, with strong analytical and documentation skills.

Qualifications

• 2 years of experience reviewing and auditing medical records.
• Experience in health plan or health insurance environment preferred.
• Ability to abstract information from medical records to ensure coding guidelines are met.

Responsibilities

• Work with SIU Investigators to discuss and determine coding outcomes.
• Analyze patient medical records for FWA investigations.
• Compare claim submissions to determine billable services and amounts.
• Determine appropriateness of billing and reimbursement.
• Document findings in spreadsheets and write reports.
• Abstract CPT, HCPCS, Revenue Codes, DRG codes, and ICD-10 from records.
• Maintain current knowledge of coding guidelines and regulations.

Skills

ICD-10

Medicare Compliance

Certified Professional Coder

Education

Bachelor's degree

Job description

Certified Medical Coder Pay Rate: 24.00 per hour 100% Remote 3-6 month contract

What You will Be Doing:

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.

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

CERTIFICATE/LICENSE

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

salary: $24 - $24.04 per hour
shift: First
work hours: 8 AM - 5 PM
education: Bachelors

Responsibilities

• 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

Skills

• ICD-10 (2 years of experience is required)
• Medicare Compliance (2 years of experience is required)
• Certified Professional Coder (2 years of experience is required)

Qualifications Years of experience: 2 years Experience level: Experienced

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
• life insurance offerings
• short-term disability
• 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.