Professional Certified Coder

DaMar Staffing; Ewing Township (NJ); On-site; USD 55,000 - 75,000; Full time

Job summary

Integrated Resources, Inc. seeks a Certified Professional Coder in Ewing, NJ. The role focuses on reviewing and translating medical policies into CPT, HCPC, and ICD-9/ICD-10 codes for system input, ensuring accurate coding aligned with legislative mandates.

You will maintain coding databases, monitor policy changes, and support benefits criteria loading, while collaborating with a cross-functional team to deliver precise clinical coding and compliance.

Qualifications

• Bachelor's Degree preferred in a relevant field.
• RHIT or CPC/CCS designation required or preferred.
• 3-5 years of Medical Coding experience in health insurance/claims processing or utilization review.

Responsibilities

• Review and interpret Medical Policies for coding input.
• Translate policy interpretations into CPT, HCPC, ICD-9/ICD-10 codes for systems.
• Monitor compliance with policies and procedures relevant to clinical data reviewed.
• Maintain a database for policies and mandates and update codes as released.
• Assist in loading benefits criteria and ensure proper edits for coding.
• Collaborate with cross-functional teams to ensure accuracy and compliance.

Skills

CPT-4

HCPC

ICD-9/ICD-10

Anatomy knowledge

Medical terminology

Communications

Team collaboration

MS Office (Word, Excel, Access)

Education

Bachelor's degree preferred

RHIT or CPC or CCS designation

Tools

McKesson ClaimsXten

CMS websites for codes

Job description

Urgent Requirement - Certified Professional CoderIntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description

Title: Certified Professional CoderLocation: Ewing, NJDuration: Full Time

Job Summary

This position is accountable for the review, interpretation and codification of Medical Policies and Legislative Mandates utilizing CPT-4, HCPC and ICD-9/ICD-10 coding parameters.

Responsibilities

• Reviews and interprets current Medical Policies for systematization.
• Translates written policy interpretation into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.
• Translates Legislative Mandates into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.
• Maintains a database for all policies and mandates that is updated each time new/revised/deleted CPT/HCPC/ICD-9/ICD-10 are released.
• Monitor compliance with policies and procedures relevant to clinical data reviewed.
• Perform updates to the criteria file to include adds/deletes/revisions of CPT-4 and HCPC codes.
• Review all codes for accuracy; review database to criteria file before implementation of policy.
• Handle internal and external areas requests to investigate current state and historical of changes made to a particular CPT-4/HCPC/Diagnosis code such as effective dates, messages used, parameter limitations.
• Review and analyze BRD/TRD/Summary to ensure accuracy of implementation of policies.
• Review of scripts concerning Edits in criteria file.
• Review logic concerning implementation of policies.
• Assist benefit file on criteria loading to best accommodate implementation of benefits.
• Ensure files (provider/criteria) are loaded correctly in order to receive proper Edits 405/406.
• Perform other related tasks as assigned.

Knowledge

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.
• Requires knowledge of anatomy, physiology and medical terminology of medical procedures, abbreviations and terms.
• Requires knowledge of the health care delivery system.

Skills and Abilities

• Requires the ability to utilize a personal computer and applicable software ( e.g. proficiency in Word, Excel, Access).
• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
• Demonstrated ability to deliver highly clinical information to technical individuals.
• Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development.
• Proven ability to exercise sound judgment and strong problem solving skills.
• Proven ability to ask probing questions and obtain thorough and relevant information.
• Must have the ability to organize/prioritize/analyze complex tasks.
• Use of CMS website for CCI rules and regulations
• Use of other approved websites for research.

Qualifications

Education/Experience:

• Bachelor's Degree preferred.
• Requires experience with McKesson ClaimsXten
• Requires a clinical medical background (Clinical editing).
• Requires a minimum of 3 years clinical experience.
• Requires 3 - 5 years of Medical Coding experience.
• Requires a minimum of 2 years' experience in Health Insurance/Claims Processing and/or Utilization Review.
• Prefer knowledge/experience with computer processing systems.
• Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist from the American Health Information Management (AHIMA).