Terms of Employment:
• W2, Contract
• 3 Months with possible extension
• Predominantly remote. There will be occasional onsite visits to our client’s office in either: Canton, MD, Washington D.C., Owings Mills, MD or Columbia, MD. Candidates must reside within the Maryland, DC, Virginia or Delaware area.
Overview & Responsibilities
Join our client’s Special Investigations Unit (SIU) as a Medical Coder, leveraging your medical coding expertise to combat fraud, waste, and abuse in healthcare claims. This vital role involves the prepayment review of medical records to ensure accurate billing per industry standards and internal policies. You will be instrumental in clearing a significant backlog of claims and contributing to the integrity of the claims process. This is an excellent opportunity for a certified medical coder seeking a high-impact role with potential for long-term employment. Key responsibilities include:
• Review medical records and claims for fraudulent indicators and coding accuracy.
• Determine if claims are accurately billed per industry standards (e.g., AMA guidance, AAPC guidance) and internal payment/medical policies.
• Render determinations on claims, which may include denying or paying them based on review findings.
• Utilize coding software (e.g., Codify, Optum Encoder Pro) or CPT manuals to aid in code review and ensure all required components of office visits are met.
• Manage a high volume of claim reviews, contributing to the reduction of a significant backlog.
Required Qualifications:
• High School Diploma or GED.
• Active and validated Certified Professional Coder (CPC) certification or equivalent accreditation (e.g., CPMA, COC, or AHIMA accreditation) without Apprentice tag.
• 3 years of experience in risk adjustment coding, ambulatory coding, and/or CRC coding experience in managed care, state or federal healthcare programs, or the health insurance industry.
• Experience in physician coding, specifically reviewing office visits and services rendered in a physician's office.
• Proficiency in reviewing medical records and claims for coding accuracy.
• Detail oriented.
Preferred Qualifications:
• Experience using coding software such as Codify (AAPC) or Optum Encoder Pro.
JRN: 2167 We are seeking a warm, experienced, and dependable full-time nanny to care for twin toddler boys (20 months old) for a lovely, easy-going family based in Calabasas, CA. The ideal candidate will have prior twin experience, be highly familiar with toddler developmental...
Description: Are you ready to make a splash in your career? Horizon Commercial Pools is on the lookout for experienced concrete finishers to join our team in either our Eden Prairie or Blaine locations. As a Finishing Technician you will be using your skills...
...We are searching for a Mold Technician for a Medical Device manufacturer in Clinton, MA. This is a 2nd shift, direct hire opportunity... ...Mold Technician must have a strong understanding of plastic injection molding and the ability to run from set up to changeover. What...
...friendly and professional Receptionist to manage the front desk and serve as the first point of contact for visitors, students, and staff. This role ensures a welcoming and efficient reception area while supporting various administrative tasks. The Receptionist will play...
...This is a fully remote role. You must live in Ohio and MUST BE admitted to practice law in Ohio. There will be court appearances near... ...disputes on behalf of clients by developing agreements, negotiating contracts, setting claims and advocating for clients in court....