Healthcare Coding Specialist

2 weeks ago

West Palm Beach, Florida, United States Dane Street, LLC Full time
Job Overview

Dane Street, LLC is on the lookout for dedicated professionals in the field of medical coding and billing. We invite experienced Coders, bill reviewers, and payment integrity specialists to become part of our dynamic team. Our organization prides itself on providing a stimulating work atmosphere, competitive remuneration, and significant opportunities for career advancement.

Position Summary:

Our new initiative within the group health sector allows you to leverage your clinical expertise to assess reports that accompany medical records, ensuring the accuracy of medical billing and coding practices. You will collaborate with fellow reviewers and their office teams to clarify information and address any inquiries, all while ensuring timely report submissions to clients.

Key Responsibilities:

  • Assess the validity of codes and verify compliance with established program criteria.
  • Ensure proper alignment of medical records with corresponding codes and obtain necessary documentation when discrepancies arise.
  • Interpret and apply policy guidelines and healthcare terminology, identifying when criteria are met or unmet.
  • Review claims for potential conflicts of interest and appropriateness of criteria.
  • Adhere to established timelines as dictated by program requirements.
  • Deliver exceptional customer service, working closely with clients on an individual basis to ensure comprehensive, timely, and accurate quality assurance of cases.
  • Provide clinical oversight for complex cases requiring additional scrutiny before returning to the client.
  • Act as an additional layer of quality assurance and clinical review for cases with identified quality concerns.

Qualifications:

Education & Experience:

● Valid CPC, AAPC, or DRG coder certification is required.

● Prior experience in payment integrity or professional bill review is highly desirable.

● Experience with out-of-network bill review is advantageous.

● Familiarity with remote work environments is preferred.

● Background in a medical office or healthcare setting is essential.

Essential Skills:

● Ability to work with urgency and meet deadlines consistently.

● Self-motivated with a strong commitment to performance excellence.

● Exceptional written and verbal communication skills are mandatory.

● Proficient in using various computer applications (experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).

● Strong attention to detail is required.

Benefits:

We offer a generous Paid Time Off policy, an outstanding benefits package, and a competitive salary. If you are a qualified candidate who thrives in a fast-paced environment and is interested in making a meaningful impact in the lives of others, we encourage you to consider this opportunity.

About Dane Street:

Dane Street is a rapidly growing, Inc. 500 Company characterized by a high-performance culture. We are in search of insightful and forward-thinking professionals. Annually, we process over 200,000 insurance claims for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, as well as Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. Our customized Independent Medical Exam and Peer Review programs assist our clients in achieving appropriate medical determinations as part of the claims management process.

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