Medicare Regulatory & Coding Expert

Acentra; United States, Northern America, Americas; Híbrido; USD 40 000 - 51 000; Tempo integral

Resumo da oferta

Acentra Health is seeking a Medicare Regulatory and Coding Expert Associate to join our team. You will maintain the ACD reference tool and monitor CMS updates, applying medical necessity criteria within the utilization management framework.

You will collaborate with clients and claims administrators, ensure compliance with CMS/URAC/ERISA guidelines, and support production goals while upholding HIPAA and confidentiality standards.

Qualificações

• Active, unrestricted RN with a Compact State License.
• Certified Medical Coder.
• Graduation from an accredited Nursing Degree Program.
• 2+ years of clinical experience after college.
• 1+ year of Utilization Management or Prior Authorization experience.
• Experience with Part B Medicare.
• Advanced level skill with Microsoft Excel.
• Knowledge of CMS regulatory requirements and compliance.
• Proficient in Microsoft Office and internet navigation.
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Experience hosting and leading meetings.

Responsabilidades

• Review CMS medical necessity and prior authorization guidelines.
• Maintain knowledge of CMS regulations and transmittals.
• Maintain ACD spreadsheet and database in Microsoft Access.
• Schedule and host ACD meetings with client.
• Review CPT reports and provide data-driven suggestions.
• Maintain and update codes in the ACD with manager/client.
• Assess patient records to determine medical necessity and appropriateness of care.
• Approve medically necessary requests; document denials with detailed rationale.
• Maintain HIPAA confidentiality and data security.
• Follow company policies including HIPAA Privacy/Security.

Conhecimentos

RN license

Certified Medical Coder

CMS knowledge

Excel

MS Office

Medical terminology

Communication skills

Team collaboration

Formação académica

Nursing degree

Certified Medical Coder certification

Ferramentas

Microsoft Access

Descrição da oferta de emprego

Acentra Health is seeking a Medicare Regulatory and Coding Expert Associate to join our team. You will maintain the ACD reference tool and monitor CMS updates, applying medical necessity criteria within the utilization management framework.

You will collaborate with clients and claims administrators, ensure compliance with CMS/URAC/ERISA guidelines, and support production goals while upholding HIPAA and confidentiality standards.