Claim Review Specialist - Coding Certification Required

CorroHealth•CA-Remote, CA

1d•Remote

About The Position

This position assists the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle, and charge/billing changes on client hospital outpatient and Profee claims using proprietary software. The role involves using software to develop standardized reports, meeting with clients, responding to coding questions clearly and concisely, and providing support to the revenue cycle consulting team. Responsibilities also include client education, preparing written FAQs, and other assigned duties. This is a remote position.

Requirements

Coding certification through AHIMA or AAPC required (we do not accept CPC-A).
Extensive experience (5+ years) in OP facility coding to include ED, SDS, I&I, OBS, E/M for facility, etc.
5+ years of current directly related experience.
Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I).
CCS, COC or CPC certification required.
Medical Terminology and anatomy knowledge is required.
Must have strong understanding of the revenue cycle, CMS Manual/guidelines, Medicaid guidelines.
Strong Microsoft Excel, PowerPoint, Word and OneNote skills.
Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS and ICD-10 CM).
Strong analytical capability, independent thinker and good decision-making skills.
Excellent written and verbal communication and presentation skills.
Strong computer and technology knowledge and skills.
Highly professional demeanor, great client satisfaction skills.

Nice To Haves

IP facility coding is a plus.
Critical Access setting experience is a plus.
Clinical Documentation and Inpatient coding experience is preferred.
New hires will be expected to learn IP during employment.

Responsibilities

Become proficient in the use of the PARA Data Editor, our proprietary software.
Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation.
Audit all aspects of claim including (but not limited to): Omitted or incorrect charges, Review OPPS and CAH charges and apply guidelines.
Audit CMS/Payer specific guidelines.
Audit Coding accuracy for ICD-10 CM, CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc).
Audit Departmental review for inaccuracies, omitted data/documentation and charges.
Audit NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, Units of services.
Audit E/M Profee/Facility Units of services.
Audit Documentation improvement.
Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries.
Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing.
Participate in presentations to clients and prospective clients, typically over web meetings.
Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services.
Keep current on all related information from journals and bulletins.
Distribute and pass on all necessary materials, including copying for reference files when relevant.
Maintain current certifications and accreditations (as applicable).
Research new guidelines, data elements, payer specifications, etc.
Other duties may be assigned as necessary.