PHRN Certified Coder
4 weeks ago
Job Responsibilities
Adheres to and maintains required levels of performance in both accuracy and productivityUnderstands ICD, CPT, and HCPCS coding guidelines and associated company policiesMaintain up-to-date Coding knowledge by reviewing materials disseminated/recommended by the QM Manager, Coding Operations Managers, and Director of Coding/Quality Management, among othersPrevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of ICD and CPT/diagnosis codes, Centers for Medicare/Medicaid Services guidelines along with referring to client specific guidelines and member policies.Identify diagnoses and procedures basis the CPT and ICD and diagnostics codes and medical records supplied by providerReview medical record documentation to identify under coded and up coded servicesResearch on provider data and member data to identify new or additional irregular billing patternsInterpret and analyze medical records as a mechanism for indexing medical information which is used for completion of statistics for hospital, regional and government planning and accurate hospital reimbursement.Review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.Identify and abstract records consistently and accurately.
Qualifications
Graduate and board passer of Bachelor of Science in NursingMust hold an active PHRN licenseAAPC or AHIMA certified or any equivalent coding certificationPreferably with medical coding experienceClaims processing experience in a BPO/HMO setting is a plus-
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