Medical Coding Reviewer

2 weeks ago


Rockville, United States Hendall Inc Full time
Job DescriptionJob Description

OVERVIEW

Hendall is seeking a Medical Coding Reviewer to examine Medicare claims for payment accuracy based on Medicare coverage, coding, and billing rules.

This position will support Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) which serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes.

DUTIES

  • Conducts independent reviews of assigned Medicare claims to determine if they were coded and paid in accordance with Medicare rules, regulations, and requirements.
  • Accurately documents review findings in system.
  • May perform second level inter-rater reliability (IRR) and difference resolution (DR) reviews.

MINIMUM QUALIFICATIONS

  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Certification
  • Experience working in the health insurance industry, a utilization review firm, or another health care claims processing organization involving medical and coding reviews of a variety of medical and surgical claims from a variety of provider types
  • Knowledge of the Medicare program, particularly coverage and payment rules
  • Knowledge and understanding of ICD-10-CM, CPT-4, and HCPCS Level II coding principles
  • Ability to apply Medicare policy knowledge and clinical experience to make payment accuracy determinations while maintaining a high level of review quality and production
  • Strong interpersonal skills, including clear oral and written communication
  • Ability to analyze, aggregate, and present data gathered from multiple sources

Hendall Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.



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