| Employer: | The CSI Companies |
| Skills: | Coding |
| Specialties: | E/M, Evaluation & Management |
| Required Certifications: | COC,CCS,CCA,RHIT,CPC |
| Preferred Certifications: | RHIT,CCS,COC,CPC,CCA |
| Required Experience: | 1 to 2 years |
| Preferred Experience: | 3 to 4 years |
| Location: | Franklin, TN |
| Date Posted: | 8/23/2019 |
Remote E/M Medical Coding Specialist/Clinical Investigator
The CSI
Companies is looking for a certified medical coder with 2 years of experience
for CPT Coding position. This is a temp to perm position with our
Fortune 500 healthcare company.
This position is set to start on October 1st, 2019.
Hours:
M-F
8am-5pm CST (100% remote)
Primary Responsibilities:
- Performs
clinical coverage review of CPT and HCPCS coded claims in a telecommuting
work environment determining payment recommendation
- Determines
appropriate level of service utilizing Evaluation and Management Coding
principles
- Ensures
adherence to state and federal compliance policies, reimbursement policies
and contract compliance
- Responsible
for Clinical and Coding expertise in the application of medical
and reimbursement policies within the claim adjudication process
through file review.
- This
could include Medical Director/physician consultations, interpretation of
state and federal mandates, applicable benefit language, medical and
reimbursement policies and consideration of relevant clinical
information
- Performs
clinical coverage review of post-service, pre-payment claims, which
requires interpretation of state and federal mandates, applicable benefit
language, medical & reimbursement policies, coding requirements and
consideration of relevant clinical information on claims with aberrant
billing patterns
- Performs
clinical coding review to ensure accuracy of medical coding and utilizes
clinical expertise and judgment to determine correct coding &
billing
- Identifies
aberrant billing patterns and trends, evidence of fraud, waste or abuse,
and recommends providers to be flagged for review
- Maintains
and manages daily case review assignments, with accountability to quality
and productivity standards
- Provides
clinical support and expertise to the other investigative and analytical
areas
- Participates
in team and network meetings, engaging in a collaborative work
environment
- Serves
as a clinical resource to other areas within the clinical investigative
team
Required Qualifications:
- High
School Diploma or GED
- 2+
years of current E/M, CPT and HCPCS coding experience (entering codes,
auditing etc.)
- Current
and active certified coder (CPC / CCS / RHIT etc.)
- Experience
with and ability to work independently with technology
- Ability
to work 8:00 am to 4:30 pm CST Monday through Friday and available to work
overtime as business needs require
- 100% Attendance is required during the first 8 weeks of
training
Preferred
Qualifications:
- Healthcare
Claims experience
- Managed
Care experience
- Investigation and/or Auditing experience