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...
- Rate: 20.9
- Location: St. Louis, US-MO
- Type: Permanent
- Industry: Finance
- Recruiter: Maximus
- Contact: Not Specified
- Email: to view click here
- Reference: 22478_MO_St Louis
- Posted: 2024-07-03 09:03:51 -
- View all Jobs from Maximus
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