Medical Coding Specialist

Duties

Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare/TRICARE to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate.

Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments.

• Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation.
• Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested.
• May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
• Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
• Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

• Working knowledge of word processing software.
• Knowledge/understanding of medical terminology and medical coding.
• Good judgment skills.
• Demonstrated customer service and organizational skills.
• Demonstrated proficiency in spelling, punctuation, and grammar skills.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.

• Knowledge/understanding of Medicare billing process.
• Working knowledge of spreadsheet and database software.

Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software.

• CCS or CPC certification required
• RN license not required

• Minimum 3 years of ICD-10 or HCC experience (mandatory)
• Risk Adjustment Coding experience (all models)
• Ability to code:
  • Minimum 25 charts per day
  • Maintain 95% accuracy

• Microsoft Office skills
• Risk adjustment coding

• Strong ICD-10 or HCC background
• High productivity and accuracy
• Detail-oriented
• Ability to work independently

• Interviews via Microsoft Teams
• 90 days of training provided

Join our team in Columbia, SC, a vibrant city that offers a perfect blend of southern charm and modern amenities. Experience an enriching career while enjoying the benefits of living in a community known for its friendly atmosphere and cultural diversity.