Immediate Opening in our PHILADELPHIA, PA OFFICE Essential Functions
Specific experience and background in CMS or commercial insurance billing, coding and reimbursement guidelines.
Direct experience in medical chart review for inpatient providers.
Responsible for reviewing medical records to determine the accuracy of coding, billing and supporting clinical documentation. Knowledge, Skills and Abilities
Knowledge of all healthcare standard code (CPT4, ICD-9, HCPCS and Revenue Codes) preferred.
Subject matter expertise in commercial insurance reimbursement/payment policies, audit reviews and analysis, and medical terminology.
Independent thinker, logical, strategic, with a high focus and attention to detail.
Effective communication and presentation style written and verbal.
Organizational skills; ability to multitask, set priorities, and meet deadlines.
Ability to creatively solve problems, deal with ambiguity.
Develop and implement policy and procedures, perform root cause analysis and present findings.
Microsoft Office: Word, Excel, PowerPoint, (Access a plus). Minimum Qualifications
BA/BS required; Masters a plus. Degree(s) in Healthcare Economics, Health Information Management and/or Business (Accounting/ Finance) preferred.
Certified Coders Required (CPCH, CCS, CPC, CCS-P, CCRC, CCS-A) - must be certified or in process of certification.
5 plus years of healthcare experience (Healthcare Recovery Auditing, Knowledge of Medical Claim Adjudication, Medical Billing, and Coordination of Benefits rules).
Coding certification required as a condition of employment (experienced candidates in process of certification will be considered).
Clinical /Nursing experience a plus
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