Medical Coding Specialist - Palmetto GBA

Palmetto GBA; South Carolina; Remote; USD 50,000 - 65,000; Full time

Job summary

A leading company is seeking a medical coder to review documentation for Medicare billing accuracy. This work-from-home position requires expertise in coding validations and offers a range of benefits, including retirement and health coverage.

Benefits

Retirement Plan

Health Coverage

Life Insurance

Paid Leave

Holidays

Wellness Programs

Tuition Assistance

Recognition Programs

Qualifications

• 1 year in ICD-9, DRG, APC, HIPPS, HCPCS coding/validation.
• 2 years combining clinical experience and coding validation.

Responsibilities

• Conduct targeted coding, documentation reviews, and validation reviews.
• Compile and analyze statistics to identify focus areas for medical review activities.
• Provide coding guidance to clinical review staff.

Skills

Medical Terminology

Customer Service

Organizational Skills

Education

Associates in a related field

Nursing Degree

Tools

Microsoft Office

Excel

Outlook

Access

Job description

3 days ago Be among the first 25 applicants

Summary

Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare 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 payments.

Description

Logistics:

• Work hours will be 8:00 am to 5:00 pm Monday through Friday.
• Work from home position. You must have high-speed (non-satellite) internet service and a private home office to work from home.

What You’ll Do

• Determine methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conduct targeted coding, documentation reviews, and validation reviews, coordinating rate adjustments and adjudication of claims. Utilize Grouper, Rover, MDS QC tool, or other software for code validation.
• Compile and analyze statistics to identify focus areas for medical review activities, noting records reviewed, outcomes, trends, and potential savings. Make recommendations to management and complete necessary documentation regarding claim information.
• Provide coding guidance to clinical review staff and develop training or reference materials.
• Consult with appeals, provider outreach, and other division areas as needed regarding medical records and coding issues.

Minimum Qualifications

• Licenses/Certificates: CCS, CPC, active RN licensure, or active multistate RN license under NLC.
• Education: Associates in a related field or nursing degree, or completion of AHIMA or AAPC exam.
• Work Experience: 1 year in ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding/validation, or 2 years combining clinical experience and coding validation.
• Skills: Knowledge of medical terminology and coding, proficiency in word processing, good judgment, customer service, organizational skills, and discretion handling sensitive info.
• Software: Microsoft Office.

Preferred Qualifications

• Experience: 2 years medical coding.
• Education: Nursing or health information management degree.
• Software: Navigating multiple programs, intermediate Excel, Outlook, Access skills.
• Knowledge: CMS guidelines, Medicare billing processes, spreadsheet/database software.

Benefits

• Retirement plan, health coverage, life insurance, paid leave, holidays, on-site amenities, wellness programs, tuition assistance, recognition programs.

Application Process

Review of resumes, possible brief interview, and interviews with top candidates.

EEO Statement

We promote nondiscrimination and provide accommodations for individuals with disabilities or religious needs. Contact us at [e-mail] or 800-288-2227, ext. 47480 for accommodations. We participate in E-Verify and are an Equal Opportunity Employer.