Quality Improvement Specialist - Remote

Proclinical Staffing; United States; Remote; USD 70,000 - 80,000; Full time

Job summary

A leading life sciences recruitment agency is seeking a Quality Improvement Specialist with expertise in laboratory coding. This remote position requires a certified medical coder experienced in ICD-10, CPT, and HCPCS. Responsibilities include developing claim rules and ensuring compliance with government programs like Medicare and Medicaid. The role involves travel one week per month for training and team activities.

Qualifications

• Certified Medical Coder (e.g., RHIT, CPC, CCS).
• Proven experience in laboratory coding.
• Strong understanding of billing and reimbursement practices.
• Familiarity with government programs (Medicare, Medicaid).
• High attention to detail with accurate documentation.
• Ability to perform configuration tasks like edit building.

Responsibilities

• Develop and implement claim editing and enforcement rules.
• Perform configuration tasks, including edit building and testing.
• Ensure compliance with Medicare and Medicaid.
• Provide insights on laboratory billing.
• Participate in monthly travel for team activities.

Skills

Certified Medical Coder

Laboratory coding experience

ICD-10 knowledge

CPT coding principles

HCPCS coding principles

Attention to detail

Job description

Proclinical is seeking a Quality Improvement Specialist with expertise in laboratory coding to join a dynamic team. This remote role requires a certified medical coder with a strong background in ICD-10, CPT, and HCPCS coding principles.

The position involves developing claim editing and enforcement rules, configuration tasks such as edit building or testing, and ensuring compliance with government programs like Medicare and Medicaid. Attention to detail and proper documentation are essential. The role also includes one week of travel per month for staff training and team-building activities.

Primary Responsibilities:

• Develop and implement claim editing and enforcement rules.
• Perform configuration tasks, including edit building and testing.
• Apply clinical expertise in ICD-10, CPT, and HCPCS coding principles.
• Ensure compliance with government programs, such as Medicare and Medicaid.
• Maintain high attention to detail and proper documentation practices.
• Provide insights into laboratory billing and reimbursement practices.
• Participate in monthly travel for staff training and team-building activities.

Skills & Requirements:

• Certified Medical Coder (e.g., RHIT, CPC, CCS, or similar).
• Proven experience in laboratory coding.
• Strong understanding of laboratory billing and reimbursement practices.
• Familiarity with government programs, including Medicare and Medicaid.
• High attention to detail and commitment to accurate documentation.
• Experience in configuration tasks, such as edit building or testing.
• Ability to travel one week per month for team-related activities.

Compensation:

• $70,000 to $80,000 per annum.

If you are having difficulty in applying or if you have any questions, please contact George Watson at [e-mail]

Proclinical is a leading life sciences recruiter focused on finding exceptional people and matching them with the finest positions across the globe. Proclinical is acting as an Employment Agency in relation to this vacancy.

Proclinical is an equal opportunities employer and welcomes applications from all qualified candidates.