Medical Coding Specialist

Location: Columbia

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* 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.
* ** Required

Education:

** Associates in a job-related field
* ** Degree Equivalency:
** Graduate of Accredited School of Nursing or successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC)
* ** Required

Work Experience:

** 1 year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; or, 2 years: 1-year clinical experience and 1 year in either DRG, APC, HIPPS, HCPCS, or RUG coding and validation.
* ** Required

Education:

** Associates in a job-related field.
* ** Degree Equivalency:
** Graduate of Accredited School of Nursing or successful completion of examination offered by American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
* ** Required

Skills and Abilities:

** 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.
* ** Required Software and Other Tools:
** Microsoft Office.
* ** Required Licenses and Certificates:
** Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) OR Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
* ** Preferred

Work Experience:

** 2 years-medical coding experience with ACA risk adjustment and HCC coding
* Previous HEDIS work experience
* *
* Preferred Education:

** Associate degree
- Nursing or Four year degree in Health Information Management.
* ** Preferred

Skills and Abilities:

** Knowledge/understanding of Medicare billing process. Working knowledge of spreadsheet and database software.
* ** Preferred Software and Other Tools:
** Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software.
* Subsidized health plans, dental and vision coverage
* 401k retirement savings plan with company match
* Life Insurance
* Paid Time Off (PTO)
* On-site cafeterias and fitness centers in major locations
* Education Assistance
* Service Recognition
* National discounts to movies, theaters, zoos, theme parks and more
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