Inpatient Medical Billing and Coding Analyst and Cost Reviewer PR

Inpatient Medical Billing and Coding Analyst and Cost Reviewer [PR0001B]

Position Type: Full-time

Pro Sidian is looking for a Inpatient Medical Billing & Coding Analyst & Cost Reviewer in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command. The role involves reviewing inpatient health records and Electronic Medical Records (EMR) for appropriate evaluation and management services, validating coding, and ensuring accurate billing.

• Prepares and maintains a variety of statistical reports and records while ensuring strict confidentiality of financial and medical records.
• Responsible for resolving questions, inconsistencies, or missing information.
• Conducts high level of bill review.
• Resolves daily coding scrubber errors to ensure accurate coding structure for correct billing.
• Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required.
• Advises and instructs providers regarding billing and documentation policies, procedures, and regulations.
• Interacts with provider staff regarding conflicting, ambiguous or non‑specific medical documentation, obtaining clarification and educating providers on changes.
• Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews; prepares periodic reports for the HCC findings, trends, and clinical staff.
• Compiles and reports HCC statistical data.

The Inpatient Medical Billing & Coding Analyst & Cost Reviewer shall have consecutive employment in a position with comparable responsibilities within the past five (5) years, must be able to use a computer to communicate via email; and proficient in Microsoft Office Products (Word/Excel/PowerPoint) and related tools and technology required for the position.

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD‑10‑CM, and HCPCS Level II classification systems.

• 2 years of experience in medical coding and billing training, risk adjustment coding or Hierarchical Condition Category (HCC) coding required; or equivalent combination of education and experience (Medical terminology, anatomy & physiology required)
• Registered Health Information Technician (RHIT) Certified Coding Specialist – Professional (CCS‑P) or Certified Coding Specialist (CCS) required. Certified coder through AHIMA or AAPC preferred but not required.
• Experience with various risk adjustment methodology and chart audits.
• Strong knowledge of CPT procedure codes and diagnostic ICD‑10‑CM codes and/or MS‑DRG classification codes, and application of modifiers.
• Ability to use computer software. Excellent communication, basic math, and reasoning skills.
• Knowledge of medical terminology, anatomy, physiology, and pathophysiology is preferred.
• Outstanding oral and written communications skills.
• Clinical background and previous chart abstraction experience is also preferred.

• Attention to Detail
• Discretion
• Computer Skills
• Office Skills
• Organizational Skills
• Writing Skills
• Operations
• Coding
• Quality
• Compliance
• Analytical abilities
• Strong morals, social skills, tech savvy.

TRAVEL: Travel is coordinated with the technical point of contact and approved in writing by the Contracting Officer in advance, in accordance with Federal Travel Regulations.

LOCATION: Work shall be conducted CONUS - Fort Stewart, GA.

• Excellent oral and written communication skills
• Analytical and evaluation skills
• Proficient with Microsoft Office Products (Microsoft Word, Excel, PowerPoint, Publisher, & Adobe)

• Teamwork:ability to foster teamwork collaboratively as a participant, and effectively as a team leader
• Leadership:ability to guide and lead colleagues on projects and initiatives
• Business Acumen:understanding and insight into how organizations perform, including business processes, data, systems, and people
• Communication:ability to effectively communicate to stakeholders of all levels orally and in writing
• Motivation:per…