Senior Inpatient Facility Coding Specialist
4 weeks ago
TriWest Healthcare Alliance is seeking a highly skilled Senior Inpatient Facility Coder to join our team. As a key member of our coding team, you will be responsible for conducting retrospective medical claims review for coding and pricing determinations and/or coding review for inpatient (facility) claims.
Key Responsibilities- Serve as a subject matter expert on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding of medical claims.
- Lead coding projects as directed by Clinical Operations management.
- Provide training and mentoring for new and existing Clinical Coders.
- Perform medical claims coding reviews using current coding guidelines.
- Identify and report potential fraudulent or quality issues.
- Act as a resource for TriWest staff on ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding.
- Research TRICARE manuals for benefits, limitations, and exclusions, current coding guidelines to assist with the Referral and Authorization Decision Support tool process.
- Monitor and track timeliness of retrospective claims reviews response to ensure compliance with required timelines for completion of assigned reviews.
- Prepare determination notices and other written correspondence.
- Identify questionable review decisions and forward to the appropriate Medical Director for evaluation and/or corrective action.
- Provide accurate data entry in the medical management and claims system.
- Review coding issues identified by the TRICARE Quality Monitoring Contractor (TQMC) & document findings, rationale, and corrective actions.
- High School Diploma or GED.
- Current certification as Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Professional Coder.
- U.S. Citizen.
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
- Minimum 5 years of clinical coding experience for facility and/or professional accounts.
- Minimum 3 years of claims processing experience for inpatient and/or outpatient accounts.
- Documented experience in a fast-paced environment.
- Experience in the private medical industry, health insurance, or Managed Care field.
- Familiarity with TRICARE and the military healthcare delivery system.
- Availability to work any shift.
- Ability to work independently from home (Remote).
- Extensive computer work with prolonged sitting.
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