Medical Coding Analyst

What you'll be doing: Performs prospective, concurrent or retrospective utilization review for all services based on the contract, state or URAC requirements. Performs coding validation to ensure that the diagnoses/procedures submitted on the claim are supported by the clinical record documentation and appropriate billing by contract. Screens individual situations according to applicable coding guidelines to determine if coding is appropriate. Refers cases that fail to meet screening criteria to peer reviewer. Coordinates and participates in peer-to-peer review as warranted. Serves as liaison between peer reviewer, provider, and/or facility. Coordinates and participates in appeal process as directed by management. Trains or serves as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified periods. Documents review and special project results in workflow documentation system, ensuring data is accurate and timely. Assists in compliance reporting. Performs preliminary research on topics such as coverage determinations, coding guidelines or standards of care. Performs miscellaneous duties as assigned.

What your background should be: Two years minimum experience in inpatient and/or outpatient coding. Certified professional coder (CPC) or certified coding specialist (CCS) or certified coding assistant (CCA) or registered health information technician (RHIT) or registered health information administrator (RHIA) required. Experience with ICD coding and concepts as well as CPT and HCPCS coding required. Intermediate experience working with Windows and PC based software products, experience working in a deadline driven environment and handling multiple tasks required.

Who is the client company: This company improves the quality and cost-effectiveness of healthcare for consumers and providers.; If you are interested in this position, send your resume to apply@kochdavis.com