Clinical Coding and Billing Analyst
1 week ago
We are looking for a highly skilled Clinical Coding and Billing Analyst to join our team at Manpower Core Group Inc. The successful candidate will be responsible for researching and identifying Medicare, Medicaid, and other medical coding and billing documents to inform our automated claims editing solution.
This solution is utilized by medical insurance payers across the United States, and the clinical content could include additions, deletions or updates to diagnosis codes, procedure codes, age minimums & maximums, quantity limitations, place of service limitations and other clinical content criteria.
The key duties and responsibilities of this role include:
- Conducting research and identifying Medicare, Medicaid, and other medical coding and billing documents to identify claim denial or covered criteria (clinical content) for our automated claims editing solution.
- Providing written and oral presentations to Medical Director (physicians) and other clinical colleagues to obtain consensus on proposed denial criteria.
- Providing clinical content support to our customers as needed.
- Performing data entry of clinical content updates into database, as needed.
- Solving problems related to the interpretation of inpatient coding or ICD-10-CM coding conventions/guidelines for inclusion or exclusion within Lyric business rules.
To be successful in this role, you will require:
- A Bachelor's Degree in Nursing.
- An Active RN (PRC) License.
- Must be an AHIMA Certified Coding Specialist - Physician (CCS-P) or AAPC Certified Professional Coder (CPC).
- At least 5 years of experience in the areas of CPT Coding, Medical Billing, Claims Processing and Chart Review/Auditing.
- Previous experience working with US health insurance payers in a claims, appeals or coding capacity is also required.
- Experience in denial management or claim review management is a plus/advantage.
- Excellent Communication Skills (verbal and written) enabling effective communication with all areas of the business.
- Proficient in using MS Office Applications.
- Amenable to Work on Night Shift.
- Amenable to Work From Home Set-Up.
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