Medical Review Coder Specialist, Medicare

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and assess sampled Medicare claims along with their corresponding medical records.

• Make payment decisions based on established coding and practice guidelines.

• Determine coding using resources such as AHA Coding Clinic and AMA CPT Assistant.

• Validate coding for ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS II, as well as MS-DRG assignments on both acute inpatient and outpatient claims.

• Review diseases, conditions, procedures, and clinical documentation to ensure codes are properly supported.

• Perform comprehensive claims analysis based on ICD-10-CM, CPT-4, and HCPCS Level II coding principles.

• Utilize electronic health information imaging and an electronic database module to document coding review outcomes.

• Access internet and intranet resources for policy validation.

• Leverage Microsoft Office and software templates for conducting claims reviews.

• Achieve established quality and production standards.

• Ensure adherence to departmental compliance with the quality management system and ISO standards.

⛳️ Requirements

• Bachelor's degree or a comparable combination of education and experience.

• Current Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) certification.

• Additional certifications such as CCS-P, CPC, COC, RHIA, or RHIT are preferred.

• At least four years of experience in inpatient, acute care coding for Medicare reimbursement.

• Experience with MS-DRG assignments and coding encoders.

• Capability to maintain strict confidentiality concerning sensitive information.

• Experience in ICD-10-CM/PCS coding.

• Must be able to meet home-office security requirements if remote work is approved.

• Must successfully complete a coding test prior to hiring in Part A DRG Medicare inpatient MS-DRG.

• Ability to remain seated for extended periods.

🏝️ Benefits

• Recognition as a military-friendly employer with support for active-duty and veteran employees.

• Option for remote work if approved.

• Support for home-office security requirements for remote locations.