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Remote - Review Nurse, Medical Coder Job in Ridgeland, Mississippi

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Job Title: Remote - Review Nurse, Medical Coder

Employer:Alliant Health Solutions
Type:FULL TIME
Job Location:Remote
Skills:Registered Nurse with Coding Certification and Utilization Experience
Specialties:Medicaid
Required Certifications:CPC,CCS or Similar Certification
Required Experience:3 to 4 years
Location: Ridgeland 39157, MS, US
* Note: This listing is for a remote position
Date Posted:4/26/2022

Alliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal and state government entities with the services, expertise and information systems necessary to increase the effectiveness, accessibility and value of health care. The Company has been named a 'Best Place to Work' for 2017, 2018, 2019, 2020 and 2021, and 'Healthiest Workplace' in 2021 by the Atlanta Business Chronicle.

Currently, the Company seeks a Review Nurse-Medical Coding, for a 3-6 month assignment.  As a member of a professional multi-disciplinary work team, this role is responsible for conducting reviews of pre-pay and retrospective claims that require a medical review prior to adjudication.  The Medical Coding Review Nurse will also conduct Utilization and Quality Management reviews of Medicaid beneficiaries for the team’s defined review types while meeting and exceeding contract expectations.   Position details are listed below.

 

ESSENTIAL JOB FUNCTIONS 

  • Adjudicate claims for providers placed on pre-payment review.
  • Perform reviews accurately and efficiently within time requirements as specified and performs accurate data entry of required review-specific information.
  • Evaluate submitted information and review claims that meet criteria and determine up-coding; make recommendation on appropriate level/ code based on record documentations. 
  • Render appropriate decisions based on the information received using the established criteria; and clearly and concisely documents the rationale for all decisions rendered.
  • Work in collaboration with Medical Review Team to oversee and support surveillance utilization review functions.
  • Identify and document suspected cases of fraud and abuse to Manager, for further referral to the Division of Medicaid’s Program Integrity Office.

 

OTHER JOB FUNCTIONS 

  • Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team.
  • Promote core values of team work, professionalism, effective communication skills and positive attitude.
  • Maintain security and confidentiality of all information in accordance with HIPAA laws, regulations, and company policies.
  • Demonstrate compliance with corporate and departmental policies as evidenced by attendance, punctuality, and professional appearance.
  • Performs other duties as assigned.

 

KNOWLEDGE, SKILLS, AND ABILITIES                       

  • Working knowledge of ICD-10-CM, CPT codes, and InterQual criteria preferred.
  • Strong theoretical clinical knowledge base and problem-solving skills.
  • Strong organizational skills with ability to demonstrate the work priorities.
  • Demonstrate ability to perform work with considerable independence by use of creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution.
  • Willingness and ability to be flexible 
  • Ability to cope with and adapt to change
  • Knowledge and general use of computers and Microsoft Office
  • Ability to type 30-50 words per minute (WPM) and data entry skills
  • Excellent interpersonal, written, and verbal skills required.
  • Must have be able to travel as needed 'driving' and/or 'going on airplane to customer locations or meetings'

 

EDUCATION, EXPERIENCE, AND TRAINING

  • Registered Nurse - Current Mississippi License required; BSN preferred
  • A minimum of 3 years of clinical care experience required
  • Previous Utilization, Case Management, Quality Assurance and/or claims auditing experience required
  • Previous medical coding experience required
  • Coding Certification required (CCS, CPC or similar)

 

 This position may be based in Ridgeland, Mississippi, or remote, and offers work/life balance and excellent benefits.

 Alliant Health Group and family of companies is an Equal Employment Opportunity Employer (EOE) and Drug Free Workplace. In compliance with the ADA Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact 678-527-3000.

Applying

Interested applicants should apply here:
https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=eed92104-3376-4806-9b1c-40ab43d4ea1c

Additional company information can be found here:  https://www.allianthealth.org/who-we-are/

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