Medical Coding Specialist (32473)

About the role

Exam Works is seeking a Medical Coding Specialist to join their team remotely. The ideal candidate must hold a current coding certification in CPC. Additional certifications such as CPMA and Certified Life Care Planner are preferred.

Responsibilities

• Create and write reports based on medical records and appropriate guideline criteria
• Utilize the system database to determine usual and customary and/or state fee schedule allowances
• Analyze provider billing for proper coding and billing guidelines across all provider types
• Ensure reviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates
• Process and review each claim and address all necessary modifications manually
• Contact clients as needed
• Perform quality assurance on every case prior to completion
• Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times
• Process client invoicing in accordance with the client’s fee schedule
• Handle and respond promptly to incoming calls, emails or faxes from clients requesting report status and/or information
• Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim
• Provide testimony in court as to the content of prepared reports, as required
• Travel as necessary
• Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations
• Perform quality assurance on various coding related reviews
• Perform other duties as assigned

Qualifications

• High school diploma or equivalent required
• Minimum one year medical billing experience; or equivalent combination of education and experience required
• Must possess current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT or RHIA
• CPMA certification preferred
• Full understanding of aspects of medical billing
• Demonstrated understanding of the various types of medical billings and ability to identify which system database should be used
• Knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines
• Complete knowledge of general computer, fax, copier, scanner, and telephone skills
• Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
• Full understanding of HIPAA regulations and compliance
• Qualified typist with a minimum of 35 W.P.M.
• Ability to follow instructions and respond to managers' directions accurately
• Ability to work independently, prioritize work activities and use time efficiently
• Maintain confidentiality
• Positive team-oriented environment
• Focus and concentration under normal or heavy distractions
• Manage change, delays, or unexpected events appropriately
• Follow all company policies and procedures in effect at time of hire and as they may change or be added from time to date

Benefits

Competitive benefits including medical, vision, dental, paid time off, and 401k. ExamWorks is an Equal Opportunity Employer.