Job Description
- Job Description:
- Review medical records and associated claim information to validate accuracy of DRG assignments and/or Itemized Billing
- Apply coding principles based on industry standards and company/client guidelines
- Validate principal diagnosis, secondary diagnoses, sequencing of diagnoses, discharge statuses and procedures utilizing the medical record
- Apply policies, procedures, guidelines and regulations developed by Centers for Medicare and Medicaid Services (CMS), commercial payers, InterQual, MCG, and Trend Health Partners
- Validate itemized bill payments utilizing the UB-04, the itemized bill and industry/client coding guidelines
- Provide appeal responses for claims of the above types utilizing industry standards and company/client policies
- Assist with new concept development
- Assist with claim selection criteria
- Maintain certifications and continuing education requirements
- May require client communication to support findings
- Requirements:
- Coding certification in good standing. Examples: CCS, CPC, CIC
- Coding validation/auditing experience
- Well-developed verbal and written communication skills coupled with recognizable organization
- Ability to effectively prioritize tasks
- Microsoft Office experience, specifically Excel
- Benefits:
- highly valued health insurance
- 401(k) plan with employer match
- paid parental leave
- comprehensive compensation package
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