Medical Case Reviewer I

Description & Requirements

Maximus is looking for a Part Time Remote Medical Coder.

The Medical Coder Position will administer and process all incoming medical records and lay evidence included with a proposal to ensure correct documents are provided to the WCMSA reviewer.

Essential Duties and Responsibilities:
- Administer and process all incoming medical records and lay evidence included with a proposal.
- Ensure correct documents are provided to the reviewer.
- Review documents determining completeness and eligibility prior to assigning to the reviewer.
- Examine case file to ensure all relevant information has been submitted.
- Contact appropriate parties for required documents and/or clarification, if not received.
- Succinctly summarize the facts for each case for the reviewer indicating what medical evidence is present supporting the set-aside proposal.
- Work closely with SMEs to develop and implement internal procedures, policy communications, work flows, QC documents, training materials and job aids.

- Abstract and code clinical data.

- Expertise with inpatient and outpatient coding; ICD-9 CM and ICD-10 codes; Current Procedural Terminology (CPT) codes; and Healthcare Common Procedure Coding System (HCPCS) practices.

- Audit medical records to ensure compliance with the organization's coding procedures and standards.

- Accurately enter coded data in systems and validate data entered.

- Research correct coding practices, clearly document and share findings with others.

- Serves as a resource and subject matter expert to project staff.

- Communicate with team members either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting medical record documentation and policies to obtain clarification to provide accurate decisions/recommendations.

- Recommend and suggest improvements to assigned projects.

- Attend meetings when necessary to provide coding expertise when requested by Management.

- Assume responsibility for professional development to maintain required credentials.

- Keep current with changes in coding guidelines, Medicare coverage guidelines, compliance, reimbursement, and other relevant regulatory updates.

- Adhere to internal controls and reporting structure.

- Comply with all relevant policies, procedures and other regulatory, compliance and accreditation standards.

- Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization.

- High School diploma or equivalent with 0-2 years of experience.

- Associate degree preferred.

- AHIMA or AAPC professional coders credentialing required (RHIT, CCS, CCS-P, CPC, CRC).

- Proficient in Microsoft Office, with accurate data entry skills.

- Strong organizational, interpersonal, written, and verbal communication skills.

- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.

- Ability to successfu...