Medical coding specialist Jobs in USA

Summary

We are currently hiring for a Medical Coding Specialist to join BlueCross BlueShield of South this role as a Medical Coding Specialist you will review medical documentation to perform a variety of coding validations for multiple lines of business under Medicare / TRICARE to determine accuracy of billing and payment reassign and sequence diagnostic and procedural codes using universally recognized coding system as appropriate and compile and analyze statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare / TRICARE payments.

Description

Location

This position is full-time (40 hours / week) Monday-Friday from 8 : 00am-4 : 30pm EST and will be hybrid in Columbia SC.

What Youll Do :

• Determines methodology to identify cases for DRG HIPPS HCPCS RUG and APC validation. Conducts targeted coding documentation reviews and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper Rover MDS QC tool or other appropriate software for code validation.
• Compiles / analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare / TRICARE payments demonstrating records reviewed outcomes trends and savings. Notes deficiencies and makes recommendations to management and others as appropriate / requested. May complete appropriate paperwork / documentation regarding claim / encounter information to correct deficiencies.
• Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
• Consults with appeals provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

To Qualify for This Position Youll Need the Following :

We Prefer That You Have the Following :

Our Comprehensive Benefits Package Includes the Following :

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

What We Can Do for You :

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next :

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will conduct interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation .

Some states have required notifications. Heres more information.

Required Experience :

IC

Key Skills

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Employment Type : Full-Time

Experience : years

Vacancy : 1