Senior Medical Coding Specialist

Blue Water Thinking; United States; Remote; USD 65,000 - 75,000; Full time

Job summary

A leading company is seeking a Senior Medical Coding Specialist to support Federal clients in improving the U.S. healthcare system. The ideal candidate will leverage their extensive coding experience and collaborate with data science teams to enhance internal processes. This role requires strong analytical skills, attention to detail, and relevant certifications.

Benefits

Health insurance (medical, dental, vision)

Paid time off

Matching 401K plan

Qualifications

• Minimum of five years experience in medical coding and provider audit.
• Professional Coding certification required.
• Experience in a Health Care system is necessary.

Responsibilities

• Analyze claim data to identify anomalies.
• Audit medical record documentation.
• Assist in developing payment integrity models.

Skills

Communication

Analytical Skills

Attention to Detail

Education

Bachelor's degree in a health related field or quantitative discipline

Tools

Microsoft Office

SQL

Job description

Guided by our principles of value generation, continuous innovation, customer-centricity, and vested collaboration, Blue Water Thinking proudly supports our Federal clients in achieving their Agency goals.

Founded by a decorated twenty-eight year Veteran of the United States Army, Blue Water Thinking understands and supports the mission of our Nation's war fighters, Veterans, their families and caretakers.

Leveraging our executive team's military experience and private and public sector consulting expertise, Blue Water Thinking takes an integrated "one-team" approach and brings to bear best-fit solutions, thought leadership, and grit to meet our client's transformational needs.

Fueled by our values of integrity, respect, professionalism, stewardship and customer service, the Blue Water Thinking team understands the power of the human connection, collaboration, humility and loyalty to one another, our clients and industry partners.

Lastly, our formula for success is simple: Build something good, take care of our people, keep our clients satisfied, nurture our work ethic and reputation, build long-lasting partnerships, enjoy what we do and give back as much as possible.

Job Description:

The Senior Medical Coding Specialist will advocate and support our team in providing data-fueled solutions that help our clients improve the U.S. healthcare system. We expect the specialist to have strong knowledge and experience with medical professional coding, facility, physician and ancillary billing, and provider reimbursement mechanisms. The successful candidate will assist in the researching of coding and billing rules and guidelines as well as the creation of documentation for machine learning models.

Responsibilities:

• Claim data analysis to identify anomalies.
• Audit medical record documentation to identify incorrectly reported services, procedures, ICD-10, HCPCS, CPT-4 codes, DRG and OPPS.
• In coordination with our data science teams, assist in designing and deployment of continuous improvement programs.
• Assist in the development and validation of the payment integrity machine learning models. These advanced computational models are responsible for the identification of claims payment anomalies, coding errors, contract misinterpretations, or internal processing payment errors.
• Participate in brainstorming sessions, finalization, and creation of presentation of client-specific solution recommendations.
• Document and communicate results of validation to clients and perform necessary follow-up.

Qualifications:

• Minimum of five years experience in the areas of medical coding and provider audit is required.
• Professional Coding certification by the American Academy of Professional Coders or the American Health Information Management Association.
• Coding experience in a Health Care system is required.
• Extensive knowledge of medical claim edits is required
• Hands-on knowledge of physician and hospital reimbursement methodologies including Medicare, Medicaid, and commercial coding practices is required
• Strong written and verbal communication skills
• Strong knowledge of Microsoft Office products is required
• Knowledge of Redshift and SQL is desired
• Bachelor’s degree in a health related field or quantitative discipline is desired.
• RN/LVN is preferred
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Must be able to obtain and maintain the required federal public trust clearance for this role

Compensation:

Salary for this position is determined by various factors, including but not limited to, location, the candidate’s particular combination of knowledge, skills, competencies and experience, as well as contract specific affordability and organizational requirements. The proposed salary range for this position is outlined below.

Salary range: $65,000-$75,000

Blue Water Thinking offers a comprehensive benefits package including health insurance (medical, dental and vision), paid time off, federal holidays, and matching 401K plan.

Our Commitment to Equal Employment Opportunity.

Blue Water Thinking, LLC (BWT) is committed to equal employment opportunity. We recruit, employ, train, compensate, and promote without regard to race, religion, color, national origin, age, sex, disability, protected veteran status, or any other basis protected by applicable federal, state, or local law.

Applying for this Job:

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• Candidates must fill out the below form to the best of their knowledge

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Are you based in the United States? * Select...

Please note that as a federal contractor supporting the Department of Veterans Affairs, we can only consider applicants who are based in the United States.

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Are you legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future? * Select...

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Do you meet ALL of the following job requirements?Minimum of five years experience in the areas of medical coding and provider audit is required.Professional Coding certification by the American Academy of Professional Coders or the American Health Information Management Association.Coding experience in a Health Care system is required.Extensive knowledge of medical claim edits is requiredHands-on knowledge of physician and hospital reimbursement methodologies including Medicare, Medicaid, and commercial coding practices is requiredStrong written and verbal communication skillsStrong knowledge of Microsoft Office products is requiredKnowledge of Redshift and SQL is desiredBachelor’s degree in a health related field or quantitative discipline is desired.RN/LVN is preferred * Select...

If not, which of the following job requirements you DO NOT meet?

High School Diploma or General Equivalency Diploma (GED) required.

6 months of customer service experienceis required.

Proficient in basic computer skills, including Microsoft Word, Excel, and Outlook.

Ability to type at least 50 words per minute.

Basic medical terminology knowledge and familiarity with VA software (VistA, CPRS, HSRM, etc.) preferred.

Strong communication skills, both oral and written, with a focus on professionalism.

Ability to work independently and resolve problems with minimal supervision.

Attention to detail and ability to maintain accurate records.

Ability to perform administrative tasks with no physical restrictions that interfere with job duties.

Compliance with VA’s infection control and immunization standards (e.g., Tuberculosis, Flu, COVID-19).

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