Medical Billing Coding Analyst

J.S. Held•Jericho, NY

1d•Remote

About The Position

We are seeking a Forensic Medical Coding & Billing Specialist to join our Medical Records and Billing team. This is a unique opportunity for an entrepreneurial, highly driven person with a well-rounded skill set to join the Medical Records and Billing team, whose responsibilities extend beyond those of traditional Forensic Medical Coding & Billing Specialist. The ideal person for this role will need to not only have a strong grasp of medical records and billing but also be flexible and a strategic thinker able to take on a variety of tasks.

Requirements

Bachelor's degree, Medical Coding, or a related field.
Certification in Medical Coding, such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist), BCSC (Billing coding Specialist Certification), Certified Professional Medical Auditor (CPMA) or CMRS (Certified Medical Reimbursement Specialist (CMRS).
Higher level coding and billing certifications
Minimum of 5 years of experience in medical billing and coding, with a focus on forensic analysis and insurance claims analysis.
In-depth understanding of healthcare billing processes, insurance claims, and regulatory guidelines.
Exceptional attention to detail and analytical skills.
Prolonged periods sitting and working at a computer

Nice To Haves

Experience in detecting fraud or discrepancies.
Masters Degree in Health Science
Familiarity with legal processes and protocols related to healthcare fraud.
Strong written and verbal communication skills, with the ability to convey complex information clearly.
Proficiency in using medical billing software and related technologies.

Responsibilities

Conduct comprehensive forensic examinations of medical records, bills, and associated documents to identify inaccuracies, misrepresentations, or instances of fraud.
Evaluate and interpret CPT, ICD, HCPCS, and other relevant coding systems to pinpoint discrepancies or inaccuracies.
Understand and navigate EHR systems and billing software.
Assist with internal or external audits regarding billing and documentation.
Serve as an expert witness in legal proceedings, providing clear, accurate, and authoritative testimony on medical coding, billing, Medicare allowances, UCR (Usual, Customary, and Reasonable) rates, EHR platforms and healthcare compliance matters.
Prepare comprehensive reports and documentation to support legal findings.
Document findings clearly and concisely, generating reports detailing discrepancies, overcharges, or suspected fraud.
Collaborate with legal and compliance teams, providing them with detailed evidence and data-backed insight for potential legal proceedings.
Stay updated on the latest medical coding and billing regulations, ensuring all analyses align with current standards and best practices.
Advise medical and administrative teams on compliance requirements and potential areas of risk.
Work closely with healthcare providers, insurance companies, and legal entities to provide expertise on medical billing and coding matters, UCR rates, proper documentation and methodology.
Serve as a consultant to payer sources and attorneys, offering guidance on best practices and potential areas of improvement.
Attend workshops, conferences, and training sessions to stay current on the latest trends and developments in the forensic medical billing and coding field.
Maintain relevant certifications and pursue additional qualifications as necessary.