A health insurance company is seeking a Telecommute Medical Coding Auditor. Candidates will be responsible for the following: Reviewing medical record information to identify all appropriate coding. Completing appropriate paperwork/documentation/system entry.
Recognizing medical/exposure cases, triaging and transferring to appropriate staff members. Promptly answering and accurately managing inbound customer service cases. Receiving and processing product refund requests. Position Requirements Include:
Minimum 2 years recent experience in medical-oriented scheduling environment. Bilingual in any of the following languages: Spanish. Adept at handling large call volumes, preferably with use of VOIP call systems. Experience with basic insurance guidelines.
Demonstrate a good working knowledge of medical terminology, human anatomy, and coding. Must possess knowledge of third party reimbursement regulations and billing practices. Possess moderate knowledge of level 1 and 2 modifiers.
Candidates will be responsible for the following: Reviewing medical records and assigning accurate codes. Maintaining 95% coding accuracy rate. Assigning the appropriate discharge disposition. Required Skills: Ability to travel when necessary; attend education meetings/in-services.
One or two years experience in a medical environment dealing with managed care or insurance issues. Must be self-motivated, detail oriented and able to prioritize workload. Successfully receive interim approval for government security clearance.
Completing initial medical records reviews of patient records within 24-48 hours of admission. Required Skills: Travel may be required to meet the needs of the facilities. Active state Registered Nurse license. Graduate from a Nursing program, BSN, or graduate.
Coding records by the appropriate coding scheme and verifying the accuracy of the data contained within the medical record. Classifying the patient into the correct MS-DRG, or other payment group, to obtain the most appropriate reimbursement. Position Requirements Include:
Knowledge of Medical terminology. Understanding of health care, PBM, and pharmaceutical industries. Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) Knowledge of pharmacy coverage review processes and guidelines.