MultiPlan | Medical Coding Specialists GA

2 weeks ago

Atlanta, United States MultiPlan Full time

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client's needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine

JOB SUMMARY: The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews in identifying any variation from quality of billing as well as monitor patient bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

  • Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analysis of charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type; and any additional information relevant to the negotiation process.
  • Apply recommendation of national coding and regulation standards to claims billed.
  • Prepare clear, concise and legible findings.
  • Research, review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation as needed.

  • Assist with, create or enhance internal claim and review recommendations.

  • Communicate with co-workers and management regarding clinical and reimbursement findings.
  • Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
  • Monitor, research, and summarize trends, coding practices, and regulatory changes.
  • Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
  • Collaborate, coordinate, and communicate across disciplines and departments.
  • Ensure compliance with HIPAA regulations and requirements.
  • Demonstrate commitment to the Company's core values.
  • Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
  • The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope: This position works independently with general supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

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