Position Summary:
Coding executives review medical records, procedure and diagnosis codes and appeal letters from providers and accordingly code or down code (accurate code) the chart for the convenience of the payers in the adjudication process.
This job is no longer available.
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Roles and Responsibilities:
- Ongoing/Retrospective reviewing of claim including medical records, procedure, and diagnosis codes and appeal letters from providers for reconsideration of coding related denials
- The coders should have knowledge of CPT coding guidelines
- The coder should have the ability/skills to identify the up-coded medical records by the provider by following current coding guidelines.
- Certified coders are responsible for examining the medical records and to determine if the edit was appropriately applied to the claim based on the information documented
- The coders will audit and re-file appeals of denied claims. Identifying frequent fraudulent practices from providers and reporting such activities to reduce fraud
- Remain abreast of all government, insurance and third-party payer regulations and assists in updating policies and procedures as appropriate to comply with current reimbursement requirements
- Requires analytical/critical thinking to validate coding and thorough review of medical records to validate medical necessity
- Sound knowledge in medical coding – ICD-9-CM; ICD-10; CPT codes, E/M, HCC, Multispecialty exposure.
- Good Knowledge of Medical Terminology and Anatomy & Physiology.
- Ability to pay attention to detail.
Education & Experience
Education – Graduate in life Sciences – Bio-Chemistry/Bio-Technology, Biomedical, Microbiology, B. Sc- Life Sciences, B. Pharma – Pharmacy, Bachelor of Physiotherapy
AAPC’s CPC, COC, CPC-H, CIC / AHIMA’s CCS; CCS-P certified Medical coders
Experience – 6Months to 2 Years of Experience in Medical coding domain (US Healthcare)
Desired Skills and Abilities:
- Good communication skills with active CPC license (ICD9/ICD10 & CPT)
- Must be a Life Science graduate with minimum 60% in their academics.
- Proficiency in MS Office tools
- Excellent knowledge in fundamentals of coding
- Multi-Specialty Coding-Denial management payer side OR E/M coding and ED
