Job Description

Job Description

Immediate need for a talented Medical Coder. This is a Fulltime opportunity with long-term potential and is located in Anchorage,AK(Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-01746

Pay Range: $28 - $29/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration.
• Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.
• Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.
• Coordinates research and responds to system inquiries and appeals.
• Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
• Conducts research of claims systems (i.e Facets, Encoder Pro, etc) and system edits to identify adjudication issues and to audit claims adjudication for accuracy
• Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.
• Mandatory experience in payor insurance processes

Key Requirements and Technology Experience:

• Key Skills:["Medical Coding", "Claims Review", "Denials & Appeals", "E&M Coding", "CPT", "HCPCS", "ICD-10", "CMS Guidelines", "Payor Processes", “Insurance Processes”].
• Certified & active Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.
• Experience with appeals and denials (NCD/LCD, Duplicate, MUE)
• 2-3 years of prior E&M/GMC experience
• Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.
• Minimum 3 years experience reviewing denied claims and performing coding audits in a healthcare or insurance environment.
• Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.
• Ability to interpret medical records and apply coding principles accurately.

Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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