Medical Review Coder Specialist (Medicare)
About The Position
Empower AI is seeking a Medical Review Coder Specialist to join their team. This role involves the review and analysis of sampled Medicare claims using associated medical records to make payment determinations based on coding and practice guidelines. The specialist will utilize various coding resources and program policies to ensure accurate coding and compliance. Empower AI is an AI for government company focused on transforming federal agencies and empowering their workforces. They are headquartered in Reston, Va., and have a proven track record in Health, Defense, and Civilian missions. Empower AI is recognized as a 2024 Military Friendly Employer.
Requirements
- Bachelor's degree or equivalent combination of education and experience.
- Active Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC).
- Minimum of four years of experience in inpatient, acute care coding for Medicare reimbursement.
- MS-DRG assignment experience and encoder experience.
- Maintain strict confidentiality to sensitive material.
- ICD-10-CM/PCS Coding experience.
- Must be able to meet home-office security requirements if approved for remote location.
- Must be able to pass a coding test prior to hiring in Part A DRG Medicare inpatient MS-DRG.
Nice To Haves
- Certified Coding Specialist- Physician based (CCS-P), or Certified Professional Coder (CPC), or Certified Outpatient Coder (COC).
- Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT).
Responsibilities
- Ensures the review and analysis of sampled Medicare claims using associated medical records, to make payment determinations based on coding and practice guidelines, and makes coding determinations utilizing American Hospital Association (AHA) Coding Clinic for ICD-9-CM, ICD-10-CM/PCS, AHA Coding Clinic for HCPCS, and the American Medical Association’s (AMA) CPT Assistant for judgment in accordance with the CERT Program policies and contract responsibilities.
- Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient hospital claims as well as outpatient.
- Review codes, diseases, conditions, and procedures on acute inpatient hospital records.
- Review general clinical documentation to ensure assigned codes are appropriately supported.
- Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles.
- Utilize electronic health information imaging and input coding review decisions by electronic database module from grouper for inpatient DRG claims.
- Utilize internet and intranet sources for policy verification.
- Utilize Microsoft Office suite and other software templates as associated source input for claims review.
- Meeting quality and production standards.
- Ensuring departmental compliance with quality managements system and ISO requirement.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
