Medical Coding Specialist - Palmetto GBA

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare company is seeking a coding validation specialist to review medical documentation for accuracy under Medicare. This work-from-home position requires a strong understanding of medical coding and the ability to analyze statistics for targeted reviews. The ideal candidate will have relevant certifications and experience in medical coding, along with strong analytical and organizational skills. Benefits include health coverage, 401(k) with company match, and tuition assistance.

Benefits

401(k) with company match

Subsidized health plans and free vision coverage

Life insurance

Paid leave and holidays

On-site amenities in major locations

Wellness programs and discounts

Tuition assistance

Recognition programs

Qualifications

• One year of ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation.
• Two years including one year clinical experience and one year coding/validation.

Responsibilities

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

Skills

Knowledge of medical terminology and coding

Proficiency in word processing

Good judgment

Customer service

Organizational skills

Analytical skills

Discretion handling sensitive information

Education

Associates in a related field

Graduation from an accredited nursing school

Tools

Microsoft Office Suite

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 systems as appropriate. Compiles and analyzes statistics to identify 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.
• This is a work-from-home position. You must have high-speed (non-satellite) internet service and a private home office.

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. Use Grouper, Rover, MDS QC tool, or other appropriate 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/encounter information to address deficiencies.
• Provide coding guidance to clinical review staff and develop training or reference materials as needed.
• Consult with appeals, provider outreach, education, and other division areas as a resource for medical records and coding issues.

Minimum Qualifications

• Licenses/Certificates: CCS, CPC, or active RN licensure in the state of employment, or an active multistate RN license under NLC.
• Education: Associates in a related field or graduation from an accredited nursing school, or successful completion of AHIMA or AAPC certification exams.
• Work Experience: One year of ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or two years including one year clinical experience and one year coding/validation.
• Skills: Knowledge of medical terminology and coding, proficiency in word processing, good judgment, customer service, organizational, and analytical skills, and discretion handling sensitive information.
• Software: Microsoft Office Suite.

Preferred Qualifications

• Experience: Two years of medical coding experience.
• Education: Nursing degree or health information management degree.
• Tools: Ability to navigate multiple Windows-based programs, with intermediate skills in Excel, Outlook, Access, and Word.
• Knowledge: CMS guidelines, Medicare Part B, and billing processes; familiarity with spreadsheets and databases.

Benefits

• 401(k) with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid leave and holidays
• On-site amenities in major locations
• Wellness programs and discounts
• Tuition assistance
• Recognition programs

Next Steps

Application review, potential phone or email interview, and interviews with top candidates.

EEO Statement

BlueCross BlueShield of South Carolina is an equal opportunity employer committed to nondiscrimination and affirmative action, providing accommodations for individuals with disabilities and other protected groups. For accommodations, contact [e-mail] or call 800-288-2227, ext. 47480.