Inpatient Facility Coding Specialist

3 days ago


Phoenix, Arizona, United States Triwest Healthcare Full time
Job Summary

We are seeking a highly skilled Inpatient Facility Coder to join our team at TriWest Healthcare Alliance. As a key member of our coding team, you will be responsible for conducting coding reviews of prior authorization requests, retrospective medical claims review, and coding review for inpatient claims. Your expertise in ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding will be essential in ensuring accurate and compliant coding practices.

Key Responsibilities
  • Perform claims coding and pricing reviews using current coding guidelines.
  • Identify and report potential fraudulent or quality issues.
  • Act as a resource for TriWest staff on coding and compliance matters.
  • Research TRICARE manuals for benefits, limitations, and exclusions.
  • Monitor and track timeliness of retrospective claims reviews.
Requirements
  • High School Diploma or GED.
  • Current certification as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT).
  • U.S. citizenship.
  • Ability to receive a favorable interim and adjudicated final Department of Defense (DOD) background investigation.
  • Minimum 2 years of clinical coding experience for either outpatient and/or inpatient accounts.
  • Minimum 2 years of claims processing experience in outpatient and/or inpatient accounts.
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.
Working Conditions

Availability to work any shift. Ability to work independently from home (Remote). Extensive computer work with prolonged sitting.

Benefits

We offer a comprehensive and progressive compensation and benefits package, including medical, dental, and vision coverage, generous paid time off, 401(k) retirement savings plan, short-term and long-term disability, basic life, and accidental death and dismemberment insurance, tuition reimbursement, paid volunteer time, and more.



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