Medical Coding Specialist

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client’s needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine!

JOB SUMMARY: The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews in identifying any variation from quality of billing as well as monitor patient bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analysis of charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type; and any additional information relevant to the negotiation process.
2. Apply recommendation of national coding and regulation standards to claims billed.
3. Prepare clear, concise and legible findings.
4. Research, review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation as needed.

5. Assist with, create or enhance internal claim and review recommendations.

6. Communicate with co-workers and management regarding clinical and reimbursement findings.
7. Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
8. Monitor, research, and summarize trends, coding practices, and regulatory changes.
9. Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate commitment to the Company’s core values.
13. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope: This position works independently with general supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use 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):

• Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor’s Degree preferred; or minimum Bachelor’s Degree in healthcare related field and at least 2 years of coding experience.
• Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-9/10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of professional claim billing requirements including HCFA­1500s, CPT codes and ICD-9/ICD-10 diagnoses codes.
• 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.
• Excellent communication (verbal and written), teamwork, training, presentation, negotiation and organizational skills.
• Ability to use hardware, software and peripherals related to job responsibilities, including MS Office Suite and database software.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

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.

The salary range for this position is $60,000-$75,000. 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.

Your benefits will include:

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program

EEO STATEMENT

MultiPlan 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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