Medical Billing Coder

US Tech Solutions; Wellesley (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading staffing firm seeks a Medical Record Reviewer to perform medical record reviews and assist with building a medical chart review program. The role requires expert knowledge in coding principles and involves preparing quality reports while adhering to compliance standards. Candidates should have a Bachelor's degree, relevant certifications, and 3-5 years of experience in coding and auditing. Excellent communication and organization skills are essential for this position, which offers flexibility between on-site and remote work.

Qualifications

• 3-5 years of experience in medical record coding and auditing.
• ICD-9/ICD-10 certification is mandatory.
• Must have experience in HEDIS chart abstractions.

Responsibilities

• Complete medical record reviews for Medicare risk adjustment.
• Mentor team members and define policies for chart review program.
• Prepare and ensure quality of reports for compliance.

Skills

CPT, HCPCS, ICD-9-CM/ICD-10-CM coding

clinical experience

advanced PC skills (Excel, Access)

excellent written communication

problem-solving skills

Education

Bachelor's Degree

RHIA, RHIT, CCS or CPC-H certification

Job description

US Tech Solutions is a global staff augmentation firm providing a wide-range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit our website www.ustechsolutions.com.

We are constantly on the lookout for professionals to fulfill the staffing needs of our clients, sets the correct expectation and thus becomes an accelerator in the mutual growth of the individual and the organization as well.

Keeping the same intent in mind, we would like you to consider the job opening with US Tech Solutions that fits your expertise and skillset.

Job Description

Medical Record Reviewer will primarily be responsible for completing medical record reviews (on-site, remote and/or in-house) in support of the Medicare risk adjustment retrospective initiative and Risk Adjustment Data Validation (RADV) Audits. This role will also assist with building the medical chart review program at Client’s.

Duties and Responsibilities

• Utilize comprehensive knowledge American Hospital Association (AHA) coding principles of CPT, HCPCS, ICD-9-CM/ICD-10-CM diagnosis and procedure codes to evaluate medical record documentation for HCC risk adjustment related activities including Medicare Advantage and Commercial Risk adjustment supplemental diagnosis capture, Medicare and Commercial RADV support, and the auditing of Client’s medical chart retrieval and coding vendors.
• Collect and document chart and coding information as required for Commercial Risk Adjustment and Medicare Advantage Risk Adjustment Client’s data collection procedures and systems.
• Assist with building the medical chart review program at Client’s including defining the operating policies and procedures, mentoring team members and input into infrastructure needs and organization.
• Utilize coding expertise to inform Revenue Management strategy development activities and may support initiatives related to coding such as provider office education.
• Responsible for developing and maintaining internal and vendor based coding guidelines.
• Provide subject matter expertise on projects related to coding practices including provider education and communications.
• Prepare reports of the data gathered and received from Client’s providers/members, ensuring reports are completed with the highest quality and integrity and that all work is in full compliance with Client’s and Regulatory requirements.
• Participate in all required training - maintaining of coding certification or other professional credentials
• Completing inter-rater reliability testing as requested
• Abide by all HIPAA and associated patient confidentiality requirements.
• Coordinate with third party and internal auditors as required.
• Other duties and projects as needed.

Qualifications

• Bachelor's Degree; Clinical experience or licensed nursing professional and 3-5 years related experience. RHIA, RHIT, CCS or CPC-H with demonstrated outpatient coding experience required. ICD-9/ICD-10 certification required.
• Experience in performing HEDIS chart abstractions; Experience in Risk Adjustment audit HCC extraction.
• Experience of healthcare delivery systems is preferred. Proven project leadership skills and ability to mentor and motivate others in the team.
• Advanced PC skills (e.g., Excel, Access, etc.) required; Excellent written and verbal communication skills, customer service skills, organization and problem solving skills, research skills, and the ability to work independently.