Professional Review Nurse - Certified Professional Coder (CPC)

OpTech • Novi, MI

70d • Hybrid

About The Position

The Professional Review Specialist provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills to determine appropriateness of medical care.

Requirements

• Certified Professional Coder (CPC) with the America Academy of Professional Coders (AAPC)
• Acute care experience - ICU, CCU, ER, OR, or orthopedics (4 yrs)
• Medical Billing and Coding - C.P.T. and I.C.D.-10 codes and billing protocols (5 yrs)
• Medical Review - medical reports, treatment plans, and billing data for appropriateness of care, treatment duration, and billing accuracy (2 yrs)
• Computer skills - MS Office Word, Excel, and Outlook

Nice To Haves

• Workers' Compensation - claims compensation processes, regulations, and medical necessity standards (preferred)
• RN/LPN preferred with Michigan active license

Responsibilities

• Audit and analyze medical billing inaccuracies and inappropriate charges
• Make decisions regarding appropriateness of billing, delivery of care and treatment plans
• Collaborate with claims examiner/client and or direct reporting manager on claim issues and/or decisions
• Appropriately document work and final conclusions in designated computer program
• Work independently, follow process guidelines, meet productivity standards and timelines. (Must maintain a score of 98% or higher on performance audits)

Benefits

• Health and dental benefits on the first day of employment
• Training opportunities
• Flexible/remote work options
• Growth opportunities
• 401K
• Competitive pay

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: Associate degree
• Number of Employees: 251-500 employees