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Clinical Coding Specialist
2 months ago
Pacer Staffing is seeking a skilled Clinical Coding Specialist to join our team. As a Clinical Coding Specialist, 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 accurate and compliant coding practices.
- 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 compliance with regulatory requirements.
- Coding Expertise: Serve as a resource for staff on ICD-10-CM, HCPCS, and CPT coding, providing guidance and support to ensure accurate coding practices.
- Research and Analysis: Research TRICARE manuals for benefits, limitations, exclusions, and current coding guidelines to ensure compliance with regulatory requirements.
- 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 accurate and compliant data management practices.
- Availability and Flexibility: Availability to work any shift to meet business needs.
- Work Environment: Works within a standard office environment, with minimal travel required.
- Computer Work: Extensive computer work with prolonged sitting required.
- Certification: Current Certification as a Professional Coder (CPC) or Certified Professional Coder Hospital (through the American Academy of Professional Coders).
- Background Investigation: If supporting TRICARE contract, must be a U.S. Citizen and 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.
- Industry Experience: Experience in the private medical industry, health insurance, or Managed Care field.
- Corporate Environment: Experience in a fast-paced corporate environment.
- TRICARE and Military Experience: Familiarity with TRICARE and the military healthcare delivery system.
- Coding Knowledge: Knowledge of ICD-10, HCPCS, and CPT coding.
- Confidentiality and Security: Ability to maintain the confidentiality and security requirements of medical records.
- Department Performance Standards: Ability to meet department performance standards.
