Special Investigations Unit Pre Pay Coding Consultant
About The Position
Coding Consultant is responsible for investigating and resolving instances of healthcare fraud and abuse of medical providers. Coding Consultant uses information from a tip, member benefits, and medical records to document relevant findings. This position will achieve applicable targets and metrics as determined. This individual will provide mentoring, explanations, and feedback to others on difficult issues. This position assists with projects both internal and external to the team. The Coding Consultant provides coding guidance to investigators on CPT codes relevant to an investigation. This position works with minimal guidance and seeks input on the most complex of tasks. Works with internal and external stakeholders to facilitate client requests and maintains compliance with regulatory requirements. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.
Requirements
- High School Diploma/GED
- Certified Coder with credentials from AAPC with a CPC or AHIMA with CCS, RHIT, RHIA
- 3+ years of CPT coding experience
- Recent professional coding/auditing experience within the last 1-2 years
- Intermediate level of proficiency with PC based software
- Ability to work our normal business hours of 8:00am – 5:00pm, Monday - Friday. It may be necessary, given the business need, to work occasionally overtime or weekends
- Must be 18 years of age or older
Nice To Haves
- Ability to prioritize and manage multiple tasks
- Proven ability to work in a team setting
- Excellent oral and written communication skills and presentation skills
- Experience with health insurance billing/coding
Responsibilities
- Reviews prepay claims with corresponding medical records to determine payment accuracy. (70%25)
- Reviews applicable policies, CPT guidelines and contracts as they pertain to clinical review. (10%25)
- Participates in regulatory meetings with the client (5%25)
- Participates in meetings with providers, advocates and legal to assist with provider abrasion. (5%25)
- Performs additional projects as needed by the business or Client; analyzes data; meets with internal and external stakeholders as necessary for resolution. (5%25)
- Continuous monitoring of claim inventory in order to adhere to performance guarantees. (5%25)
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
