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Medical Coding Specialist

1 month ago

Detroit, Michigan, United States Strategic Staffing Solutions Full time
Job Title: Medical Coder

Job Summary:

This role is responsible for coordinating activities within the clinical editing unit, focusing on the development, implementation, and decision-making related to clinical editing software. The successful candidate will analyze reports to determine appropriate payment levels based on standard billing practices and medical coding standards.

Key Responsibilities:

  • Develop and implement clinical editing software to determine the appropriateness of billing and reimbursement.
  • Analyze reports to determine payment levels based on standard billing practices and medical coding standards.
  • Collaborate with internal departments to provide technical expertise and support.
  • Maintain documentation, including completion of logs and database, related to appeals and inquiries.
  • Handle and resolve issues identified on reports.

Requirements:

  • Associate degree or two years of college required, with a preferred area of concentration in business, information systems, or a healthcare-related field.
  • Coding certification preferred (e.g., CPC certification).
  • Minimum of four years of experience in billing and coding, claims resolution, or a related field.
  • Working knowledge of medical coding standards, including HCPCS, CPT, ICD-10, etc.
  • Knowledge of NCQA, CMS, State, and Federal HMO regulations preferred.

Education:

  • Associate's degree in business or a healthcare-related field.
  • Three years of related experience in managed care operations, including specific functional experience related to the assigned department.

Company Overview:

Strategic Staffing Solutions is a leading provider of staffing services, dedicated to connecting top talent with innovative companies. We pride ourselves on our commitment to excellence, customer satisfaction, and community involvement.