Claim adjuster Jobs in Washington, DC

Benefits:

• Bonus based on performance
• Opportunity for advancement
• Paid time off

- Analyze medical claims data to identify trends and potential financial risk across all Medicaid provider types;


- Identifies procedures based on Coding Guidelines and confirms accuracy and compliance;


- Conducts specialized and focused internal audits of physician and non-physician providers as well as facility-based care billing practices;


- Evaluates the appropriateness of ICD-10m HCPCS and CPT codes, APC/EAPG, DRG, and modifier usage, based on medical center policies and related payor requirements;


- Makes determination of overpayments and underpayments and performs other related analysis and evaluations; and Assist in developing payment models.

- Minimum Qualifications for Medical Claims Adjuster 5.3.3.1 Associate Degree in Medical Billing or Medical Coding;


- Minimum of three years practical experience in Medical Billing or Medical Coding;

- Knowledge of the general field and basic principles, concepts, and methodology of Outpatient and Inpatient Code Sets;


- Knowledge and skill sufficient to use appropriate terminology regarding coding nomenclature for inpatient and outpatient services;


- Knowledge and skills in Microsoft Excel software application;


- Ability to communicate both orally and in writing in order to communicate with both in-house staff and external providers;


- Knowledge of laws pertaining to Protected Health Information and the penalties for unauthorized disclosures;


- Strong attention to detail and a thorough understanding of medical terminology, anatomy, and physiology are essential;


- Minimum of five to ten years coding experience in a healthcare setting;


- Proficiency in EHR software and other billing systems is required;


- Strong analytical and organizational skills;


- Understanding of Alternative Payment Models (AMPs) and Bundled Payments;


- Ability to analyze medical records and identify coding or billing issues;


- Effective communication skills with providers, stakeholders,


- In-depth knowledge of Healthcare Common procedure Coding System (HCPCS), CPT, ICD-10-CM and ICD-10-PCS coding systems;

- Associate’s or Bachelor’s degree or Certification in Certified Professional Coder (CPC), CPC+CPB, BCSC, CMRS, Certified Coding Specialist (CCS);


- Certified Coding Specialist (CCS) from AHIMA is preferred


- Excellent communication skills in writing, oral presentations, public speaking, and computer literacy (Microsoft Word, Outlook, Excel and Power Point).


- Ability to exercise tact, discretion, and skill in personal relations in dealing with persons at various levels, and groups, especially in public forum;