Healthcare Outpatient Coding Analyst Posted Dec 30, 2016
All Med Search , Helena, GA
Healthcare Outpatient Coding Analyst


The Healthcare Outpatient Coding Analyst's focus is to work within a team environment to create and maintain audit concepts for the company through policy research, data analysis, examination of opportunity, preparation of rule documents and code lists, and apply policy & rule updates to existing edits.

As a key member of the Research and Concept Preparation team, core responsibilities include:

• Identifying and developing new concepts to recoup inappropriate claims payment for Medicare, Medicaid and Commercial lines of business.

• Identifying concepts for potential recoupment through automated and clinical audits by analyzing health services utilization data (e.g., Medicare claims) and researching sources of new issues (e.g., OIG reports, Medicare rules, coding guidelines, groupers/pricers, etc)

• Researching audit concepts approved for development

• Applying appropriate Medicare, Medicaid and other regulatory policy and rules

• Participating in development of new concept packages by:

• Helping to update the companys work plan and/or audit plan as appropriate

• Completing all post-approval tasks and updating the Post-approval Log

• Working in partnership with CMS, CMD, department co-workers and across departments

• Keeping abreast of medical practice, changes in technology, and regulatory issues that may affect client contracts

• Working with internal HCS teams and areas to improve processes and customer satisfaction

• Providing training to Customer Service for automated issues and to Audit Delivery auditors, when requested

• Suggesting ideas to improve work flow and improve processes

• Participating in development and revision of standard operating procedures

• Performing claims look-up in source systems as needed (Common Working File, MAC system, client claim systems, etc)

• Collaborating with subcontractors, including mentoring, training and QA of their work

• Attending MAC clinical calls and discussing new issues, as appropriate

• Completing weekly status and other reports

• Cross training in departments/areas, as requested

• Performing miscellaneous duties as assigned in a highly professional manner

• Attending conference calls and all meetings as requested

• Assist with training team members as applicable

• Cross train in other departments as applicable

• Maintain required quality and productivity standards

• Performs other duties as assigned

Required Skills and Knowledge:

• Expertise in ICD-9-CM, ICD-10-CM/PCS, CPT-4, and HCPCS coding, especially Ambulatory Payment Classification (APC) coding

• Knowledge of the national coding standards, particularly payment rules for APC claims

• Knowledge of commercial claims processing systems

• Knowledge of the Medicare program, particularly medical policy and payment rules

• Knowledge of Medicare claims processing systems

• Excellent written and verbal communication skills

• Proficient in MicroSoft Word, Excel, SharePoint (advanced skills highly desirable)

• Must be able to independently use standard office computer and other technology (e.g., email, telephone, scanner) and have experience using a platform to review and document findings

• Excellent analytical skills, including the ability to analyze health services utilization data(e.g., claims data)

• Ability to understand and apply complex policies, procedures, regulations and legal statutes

• Ability to manage multiple tasks and track multiple issues over time and in different phases of development

• Must be able to manage multiple assignments effectively, create documentation, organize and prioritize workload, problem solve, work independently and with team members, including remote coworkers and other partners

• Courteous, professional and respectful attitude

• Flexibility to handle non-standard situations as they arise

• Ability to problem solve and to interact with management to suggest improvements in processes/procedures to maximize productivity

• Ability to maintain high quality work while meeting strict deadlines.

• Excellent written and verbal communication skills.

• Experience using the following applications is preferred: Word, Excel, and e-mail

Physical Requirements:

• Keying frequency, handling, reaching, fine manipulation

• Sit/stand/walk 8-12hr/day

• Lift/carry/push/pull under and over 10lbs occasionally

Education and Experience:

• Some college preferred

• Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P

• Strong preference for experience working in medical policy or claims unit of a Medicare contractor (e.g., MAC, ZPIC)

• Minimum 5 years of Medicare medical policy and editing experience

• BS/BA (or Advanced degree) or comparable work experience

• Expertise in ICD-9-CM, ICD-10-CM/PCS, CPT-4, and HCPCS coding;

• Strong preference for experience working in a claims unit of a commercial contractor, as edit developer for a commercial insurer, or as a medical biller with a wide range of experience

• Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.

• Experience using Microsoft Excel and other Microsoft Office applications

For more information and to apply, please reply to this job posting and attach your resume in a word doc.

About the Company

All Med Search is your dynamic, versatile healthcare recruiting powerhouse with an impressive history of PERMANENT Healthcare PLACEMENT in Healthcare facilities across the USA. We have been doing this successfully since 1992 by matching the right individual to the right job in the right organization......

Employment Type: Permanent

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