Medical Coding Specialist

TALENT Software Services; Columbia (SC); On-site; USD 45,000 - 60,000; Full time

Job summary

A healthcare services provider in Columbia, South Carolina, is seeking a Medical Coding Specialist to review medical documentation for coding validations under Medicare and TRICARE. Responsibilities include conducting targeted coding reviews, analyzing statistics for potential billing issues, and providing guidance to clinical staff. The ideal candidate will have relevant coding experience, an Associate Degree in Health Information Management, and strong analytical skills. Certifications like CCS or CPC are required. This role is vital for ensuring accurate billing in compliance with healthcare standards.

Qualifications

• 1 year of ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding experience or 2 years with a mix of clinical and coding experience.
• Active certification as a CCS or CPC or active RN licensure in the hired state.

Responsibilities

• Review medical documentation for coding validations under Medicare/TRICARE.
• Conduct targeted coding and documentation reviews for validation.
• Provide coding guidance and develop training materials for staff.
• Analyze statistics to identify areas for medical review.

Skills

Working knowledge of word processing software

Knowledge/understanding of medical terminology

Good judgment skills

Demonstrated customer service skills

Demonstrated proficiency in spelling, punctuation, and grammar

Analytical or critical thinking skills

Ability to handle confidential information with discretion

Education

Associate Degree - Health Information Management

Tools

Microsoft Excel

Microsoft Access

Microsoft Office

Job description

Duties:

Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.

• 60% Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation.
• 25% Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
• 10% Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
• 5% Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

Skills – Required:

• Working knowledge of word processing software.
• Knowledge/understanding of medical terminology and medical coding.
• Good judgment skills.
• Demonstrated customer service and organizational skills.
• Demonstrated proficiency in spelling, punctuation, and grammar skills.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.

Preferred Skills and Abilities:

• Knowledge/understanding of Medicare billing process.
• Working knowledge of spreadsheet and database software.

Preferred Software and Other Tools:

• Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software.

Education – Required:

• Associate Degree - Health Information Management, OR, Graduate of an Accredited School of Nursing, OR, successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC).

Required Work Experience:

• 1 year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or, 2 years: 1 year clinical experience and 1 year in either DRG, APC, HIPPS, HCPCS, or RUG coding and validation.

Required Software and Other Tools:

• Microsoft Office.

Required Licenses and Certificates:

• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) OR Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

Preferred Education:

• Associate Degree- Nursing or Four year degree in Health Information Management.

Preferred Work Experience:

• 2 years-medical coding experience.