Coding Analyst

Position Purpose:  Ensure the coding accuracy and compliance Part A and B claims during the course of FWA Monitoring activities, Special Investigations and other program integrity initiatives.
Responsibilities:

• Responsible for the analysis of Part A and B claims in order to assess accuracy of claims coding
• Analysis includes the review of coding guidelines, clinical records, reimbursement guidelines (including MS-DRG, AP-DRG and APR-DRG payment systems)
• Identifies patterns for outlier claims (e.g. upcoding, unbundling, misuse of modifiers, diagnoses not adding up to a DRG, etc.) and is able to generate high-quality recoverable claims
• Provides support for findings, determinations and recommendations; and generate audit letters
• Complies with the CMS Program Integrity Manual and Statement of Work guidelines
• Maintain chain of custody of all documents; follow confidentiality and security guidelines
• Works in collaboration with the Clinical Reviewer assigned to the Operations area, as well as the Manager of FWA and VP of Administration
• Meet performance goals established for the position
• Performs other duties and responsibilities as assigned by management

Qualifications:

• 5-7 years of experience of working with ISD/9/10 CM, CPTs, HCPCS, Diagnostic Related Groups (DRGs) and Prospective Payment Systems
• Knowledge of Medicare claims coding and terminology; billing and claims processing systems; provider billing guidelines, payer reimbursement policies, medical necessity criteria and industry-based standards
• Associate or Bachelor’s degree in Nursing (active/unrestricted license), or Associate or Bachelor’s degree in Health Information Management (RHIA or RHIT); equivalent experience of 5 years in claims auditing, quality assurance, or recovery auditing in a DRG / clinical validation audit setting or hospital environment
• Coding Certification: RHIA or RHIT, Inpatient Coding Credential – CCS or CIC preferred; candidates who hold a CCDS or CPC will be given consideration, but will need to obtain an inpatient coding certification within 1 year of their hire date with the company
• Strong analytical and critical thinking skills
• Excellent written and verbal communication skills
• Ability to manage priorities and execute tasks in a high-pressure environment
• Proficiency in MS Word, MS Excel and MS PowerPoint
• Associate or Bachelor’s degree in Nursing (active/unrestricted license), or Associate or Bachelor’s degree in Health Information Management (RHIA or RHIT); equivalent experience of 5 years in claims auditing, quality assurance, or recovery auditing in a DRG / clinical validation audit setting or hospital environment
• Coding Certification: RHIA or RHIT, Inpatient Coding Credential – CCS or CIC preferred; candidates who hold a CCDS or CPC will be given consideration, but will need to obtain an inpatient coding certification within 1 year of their hire date with the company
• Strong analytical and critical thinking skills
• Excellent written and verbal communication skills
• Ability to manage priorities and execute tasks in a high-pressure environment
• Proficiency in MS Word, MS Excel and MS PowerPoint  

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.   

No Third Party Agencies or Submissions Will Be Accepted.   
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP   
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.