Medical Coding Specialist (32635)

About the role

The Medical Coding Specialist will join our team remotely. The role requires a current coding certification in CPC, with CPMA certification and Certified Life Care Planner certification being 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 and 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.
• 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.
• Handle travel as necessary.
• Maintain confidentiality and adhere to 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.
• Ability to cross reference different types of billings to ensure consistency in the review process.
• 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.
• Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• A full understanding of HIPAA regulations and compliance.
• Able to follow instructions and respond to managements’ directions accurately.
• Able to work independently, prioritize work activities and use time efficiently.
• Able to maintain confidentiality.
• Able to demonstrate and promote a positive team-oriented environment.
• Able to stay focused and concentrate under normal or heavy distractions.
• Able to work well under pressure and or stressful conditions.
• Able to manage change, delays, or unexpected events appropriately.
• Able to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

Benefits

Competitive benefits including medical, vision, dental, paid time off, and 401k. Equal Opportunity Employer - Minorities/Females/Disabled/Veterans. ExamWorks, LLC is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.