Benefits:

Bonus based on performance

Opportunity for advancement

Paid time off

• Analyze medical claims data to identify trends and potential financial risk across all Medicaid provider types;

• Identifies procedures based on Coding Guidelines and confirms accuracy and compliance;

• Conducts specialized and focused internal audits of physician and non-physician providers as well as facility-based care billing practices;

• Evaluates the appropriateness of ICD-10m HCPCS and CPT codes, APC/EAPG, DRG, and modifier usage, based on medical center policies and related payor requirements;

• Makes determination of overpayments and underpayments and performs other related analysis and evaluations; and Assist in developing payment models.

• Minimum Qualifications for Medical Claims Adjuster 5.3.3.1 Associate Degree in Medical Billing or Medical Coding;

• Minimum of three years practical experience in Medical Billing or Medical Coding;

• Knowledge of the general field and basic principles, concepts, and methodology of Outpatient and Inpatient Code Sets;

• Knowledge and skill sufficient to use appropriate terminology regarding coding nomenclature for inpatient and outpatient services;

• Knowledge and skills in Microsoft Excel software application;

• Ability to communicate both orally and in writing in order to communicate with both in-house staff and external providers;

• Knowledge of laws pertaining to Protected Health Information and the penalties for unauthorized disclosures;

• Strong attention to detail and a thorough understanding of medical terminology, anatomy, and physiology are essential;

• Minimum of five to ten years coding experience in a healthcare setting;

• Proficiency in EHR software and other billing systems is required;

• Strong analytical and organizational skills;

• Understanding of Alternative Payment Models (AMPs) and Bundled Payments;

• Ability to analyze medical records and identify coding or billing issues;

• Effective communication skills with providers, stakeholders,

• In-depth knowledge of Healthcare Common procedure Coding System (HCPCS), CPT, ICD-10-CM and ICD-10-PCS coding systems;

• Associate’s or Bachelor’s degree or Certification in Certified Professional Coder (CPC), CPC+CPB, BCSC, CMRS, Certified Coding Specialist (CCS);

• Certified Coding Specialist (CCS) from AHIMA is preferred

• Excellent communication skills in writing, oral presentations, public speaking, and computer literacy (Microsoft Word, Outlook, Excel and Power Point).

• Ability to exercise tact, discretion, and skill in personal relations in dealing with persons at various levels, and groups, especially in public forum;