Claim Review Specialist - Facility Coding
New
J
JobgetherHealthcare Revenue Cycle
United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years
- Required Skills
- Microsoft ExcelPowerPoint
Requirements
- 5+ years of current, directly relevant experience in outpatient facility coding.
- Current CCS, COC, or CPC certification through AHIMA or AAPC (CPC-A not accepted).
- Extensive expertise in outpatient facility coding (emergency department, same-day surgery, observation, ancillary services, interventional radiology, facility E/M).
- Strong knowledge of revenue cycle processes, CMS guidelines, Medicare, Medicaid, and payer-specific rules.
- Working knowledge of ICD-10-CM, CPT, HCPCS, revenue codes, NCCI/CCI edits, MUEs, and OPPS reimbursement.
- Understanding of medical terminology, anatomy, and clinical documentation.
- Strong analytical, research, critical-thinking, and decision-making abilities.
- Excellent written and verbal communication and client-service skills.
- Proficiency with Microsoft Excel, PowerPoint, Word, and OneNote.
- Ability to work effectively from a home office.
Responsibilities
- Review outpatient hospital and professional-fee claims using proprietary software, data trends, and supporting medical documentation.
- Conduct comprehensive claim audits covering omitted or incorrect charges, coding accuracy, documentation, units of service, and billing elements.
- Apply OPPS, Critical Access Hospital, CMS, Medicare, Medicaid, Medi-Cal, payer-specific, NCCI, and MUE guidelines as applicable.
- Evaluate ICD-10-CM, CPT, and HCPCS coding, including facility E/M, emergency department, same-day surgery, observation, ancillary, interventional radiology, and related services.
- Identify coding, charge, billing, and documentation improvement opportunities and recommend appropriate changes.
- Research new coding guidelines, payer specifications, data elements, and reimbursement requirements to maintain current expertise.
- Support client meetings and presentations and contribute educational content for clients and internal teams.
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