Medical Review Coder Specialist (Medicare)

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The Medical Review Coder Specialist ensures the review and analysis of sampled Medicare claims using associated medical records, to make payment determinations based on coding and practice guidelines, and makes coding determinations utilizing American Hospital Association (AHA) Coding Clinic for ICD-9-CM, ICD-10-CM/PCS, AHA Coding Clinic for HCPCS, and the American Medical Association's (AMA) CPT Assistant for judgment in accordance with the CERT Program policies and contract responsibilities.

Highlights of Responsibilities:

Analyze medical records to validate ICD-10-CM, ICD-10-PCS, CPT-4, HCPCS II coding and MS-DRG assignment on acute inpatient hospital claims as well as outpatient.
• Review codes, diseases, conditions, and procedures on acute inpatient hospital records -Review general clinical documentation to ensure assigned codes are appropriately supported
• Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles
• Utilize electronic health information imaging and input coding review decisions by electronic database module from grouper for inpatient DRG claims.
• Utilize internet and intranet sources for policy verification.
• Utilize Microsoft Office suite and other software templates as associated source input for claims review.
• Meeting quality and production standards.
• Ensuring departmental compliance with quality managements system and ISO requirement

Minimum Requirements:

• Bachelor's degree or equivalent combination of education and experience
• Active Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) and preferred as well- one of these certifications: Certified Coding Specialist- Physician based (CCS-P), or Certified Professional Coder (CPC), or Certified Outpatient Coder (COC).) 0r Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT)
• Minimum of four years of experience in inpatient, acute care coding for Medicare reimbursement
• MS-DRG assignment experience and encoder experience
• Maintain strict confidentiality to sensitive material
• ICD-10-CM/PCS Coding experience
• Must be able to meet home-office security requirements if approved for remote location.
• Must be able to pass a coding test prior to hiring in Part A DRG Medicare inpatient MS-DRG.

Physical Requirements:

This position requires the ability to perform the below essential functions:

• Sitting for long periods

All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm's overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.