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