Clinical Coder Specialist

3 days ago


Atlanta, Georgia, United States Pacer Staffing Full time
Job Summary:

Pacer Staffing is seeking a skilled Clinical Coder to join our team. As a Clinical Coder, you will be responsible for conducting retrospective medical claim reviews and adjudication for coding determinations.

Key Responsibilities:
  • Claims Coding Reviews: Perform claims coding reviews using current coding guidelines to ensure accuracy and compliance.
  • Focused Claims Reviews: Conduct focused claims reviews as requested by management and summarize findings to identify potential issues.
  • Quality Assurance: Identify and report potential fraudulent or quality issues to ensure the integrity of our claims process.
  • Coding Expertise: Serve as a resource for Pacer Staffing staff on ICD-10-CM, HCPCS, and CPT coding to ensure consistency and accuracy.
  • Research and Analysis: Research TRICARE manuals for benefits, limitations, exclusions, and current coding guidelines to stay up-to-date on industry developments.
  • Timeliness and Compliance: Monitor and track timeliness of retrospective claims reviews to ensure compliance with required timelines.
  • Review and Escalation: Identify questionable review decisions and escalate to the appropriate Medical Director for evaluation and/or corrective action.
  • Data Entry and Management: Provide accurate data entry in medical management and claims systems to ensure seamless data flow.
  • Additional Responsibilities: Perform other duties as assigned to support the success of our team.
Working Conditions:
  • Availability: Availability to work any shift to meet the needs of our clients.
  • Work Environment: Works within a standard office environment, with minimal travel required.
  • Computer Work: Extensive computer work with prolonged sitting to ensure efficient data entry and management.
Education and Experience:
  • Certification: Current Certification as a Professional Coder (CPC) or Certified Professional Coder Hospital (through the American Academy of Professional Coders).
  • U.S. Citizenship: If supporting TRICARE contract, must be a U.S. Citizen.
  • Background Investigation: If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
  • Experience: 2+ years of clinical coding experience and 2+ years of claims processing experience.
  • Preferred Qualifications: Experience in the private medical industry, health insurance, or Managed Care field; experience in a fast-paced corporate environment; familiarity with TRICARE and the military healthcare delivery system.
  • Technical Skills: Knowledge of ICD-10, HCPCS, and CPT coding; ability to maintain the confidentiality and security requirements of medical records; ability to meet department performance standards.


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