At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple – we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders — internal and external – driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and upward!!!
The Senior Medical Coding Specialist provides analysis of the highest dollar and most complex claims by applying research, coding standards, industry knowledge and federal regulations to ensure correct billing practices. In this role, incumbent will perform reviews to identify variations from quality of billing as well as to monitor bills for accuracy and compliance.
JOB ROLES AND RESPONSIBILITIES:
JOB SCOPE:
This position works independently with minimal supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. More complex issues are referred to higher levels. The incumbent follows established procedures and uses knowledge of the Company’s general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.
Qualifications
JOB REQUIREMENTS (Education, Experience, and Training):
* Completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; and at least 5 years of coding experience.
* Current nursing certification, coding credential (CCS, CCS-P or CPC), or Registered Health Information Technician credential(RHIA/RHIT) required and maintained as a condition of employment.
* Minimum 5 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
* Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs.
* Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria and applicable industry standards.
* Knowledge of commonly used medical data resources such as MDR, Medical Fees in the US, etc.
* Auditing and health information management experience in a healthcare setting preferred.
* Required licensures, professional certifications, and/or Board certifications as applicable.
* Experience with professional and facility contract interpretation.
* Experience and proficiency using MS Office Suites: Excel, Outlook and PowerPoint. Visio helpful.
* Excellent communication (written, verbal and listening), interpersonal, organizational, time-management, analytical, problem-solving, trouble-shooting, customer service skills.
* Ability to develop educational materials and job aids pertaining to coding and claims.
* Ability to work evening or weekend hours as needed to meet deadlines.
* Ability to handle multiple tasks in a fast paced environment.
* Ability to meet individual and team goals, deadlines and work standards.
* Ability to apply independent judgment and determine appropriate course of action.
* Ability to read and abstract medical records.
* Knowledge of medical terminology, anatomy, and physiology.
* Ability to interact and discuss results with providers.
* Ability to lead, teach, mentor others, and facilitate a learning environment.
The salary range for this position is $75-90K. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
BENEFITS
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
APPLICATION DEADLINE
We will generally accept applications for at least 15 calendar days from the posting date or as long as the job remains posted.
EEO STATEMENT
Claritev is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.
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Claritev is hiring a remote Senior Medical Coding Specialist from πΊπΈ USA
This is a Full Time role.
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