Responsibilities:
- Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement.
- Respond to provider appeals.
- Respond to client logic and record reviews.
- Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
- Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
- Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
Requirements:
- Active professional license as a Registered Nurse in your current state of residence.
- 1 year professional experience in providing direct patient care.
Coding Certification Preferred (Outpatient – CPC, CCS or CCS-P) or willingness to obtain one.
Expected Professional Competencies:
- Has general knowledge of medical procedures, conditions, illnesses and treatment practices.
- Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
- Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
Additional information on work environment
- This position may require after hours, weekend or holiday hours to accomplish client objectives. This is an hourly position and employees will be compensated accordingly.
- Training for this position lasts 8 – 10 weeks and can be completed remotely, time off during the training period would not be preferred.
- Start date is June 24, 2019; hours during training are 7 AM – 3 PM MT
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.