Niles Executive Recruitment Jobs

Certified Coding Specialist Posted Jan 31
Confidential, Cincinnati, OH (Cincinnati Area)
Position Title Certified Coding Specialist - Cincinnati Area
Relocation No
Location Cincinnati Area
Salary Depends on Qualifications

Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.

Essential Duties and Responsibilities:

• Research, communicate and educate others on coding changes that impact reimbursement
• Identify areas of opportunity that occur as a result of a coding or billing error
• Review insurance contracts to gain thorough understanding of payment methodologies
• Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
• Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
• Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and presentations
• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other personnel
• Support and direct claims to all departments and client onsite analysts
• Build strong, lasting relationships with clients, payors and personnel
• Attend client, department and company meetings
• Comply with federal and state laws, company and department policies and procedures

Essential Skills and Experience:

• Minimum 2-years of experience working with hospital claims in some capacity
• Familiarity with hospital billing guidelines and requirements
• Knowledge of healthcare codes including CPT, HCPCS, ICD-9, ICD-10, DRG and ability to correctly use and apply codes in an operational setting
• Ability to read and interpret an extensive variety of documents such as contracts, claims, medical records, EOB's, policies and procedures in written (English) and diagram form
• Familiarity with CDM and its impact on reimbursement
• High School diploma or equivalent
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong organization and time management skills
• Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
• Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
• Strong customer service orientation
• Excellent interpersonal and communication skills
• Strong team player
• Commitment to company values

Non-Essential Skills and Experience:

• Related Professional License/Certification(s)
• Associate or Bachelor's Degree(s)