Senior Clinical Coder (Inpatient Coder)

About the role

Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Responsibilities

• Serves as the subject matter expert and resource on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding of medical claims.
• Takes the lead role for coding projects as directed by Clinical Operations management.
• Provides training and mentoring for new and existing Clinical Coders.
• Performs DRG Validation of medical claims coding using current coding guidelines and support software.
• Performs focused outpatient and/or inpatient claims reviews as requested by management and summarizes findings.
• Identifies and reports potential fraudulent or quality issues.
• Acts as a resource for TriWest staff on ICD-10-CM, ICD-10-PCS, CPT and HCPCS coding.
• Researches TRICARE manuals for benefits, limitations and exclusions, current coding guidelines to assist with the Referral and Authorization Decision Support tool process.
• Maintains the confidentiality and security requirements of medical records.
• Prepares determination notices and other written correspondence.
• Identifies questionable review decisions and forwards to the appropriate Medical Director for evaluation and/or corrective action.
• Provides accurate data entry in the medical management and claims system.
• Reviews coding issues identified by the TRICARE Quality Monitoring Contractor (TQMC) & documents findings, rationale, and corrective actions.
• Performs other duties as assigned.

Requirements

• High School Diploma or GED
• Current certification as Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
• U.S. Citizen
• Minimum 5 years of clinical coding experience for facility and/or professional accounts
• Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts
• Documented experience in a fast-paced environment

Qualifications

• Preferred Experience in the private medical industry, health insurance or Managed Care field
• Familiarity with TRICARE and the military healthcare delivery system

Skills

• Communication / People Skills
• Computer Literacy
• Coping / Flexibility
• Independent Thinking / Self-Initiative
• Information Management
• Organizational Skills
• Problem Solving / Analysis
• Team-Building / Team Player
• Technical Skills

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Pay

Salary Range: Around $80,000 - $84,000 per year

Schedule

Availability to work any shift