Medical Coder III at LanceSoft, Inc. in Remote, CA

Job description

• Job Title: Medical Coder III
• Schedule: 7-4pm or 8-5pm local time M-F
• Hours per Week: 30-40 hrs
• Estimated OT Hours per Week: 5-10 hrs, if applicable
• Location: 100% Remote
• Duration: 1 Year
• Serves as the primary resource for medical coding updates and information. Advises client on coding issues, provides in-depth research on new or unusual procedures, and makes recommendations when appropriate. Provides support to the Claims and Provider Relations Departments

Responsibilities

• o Reviews and researches billed unlisted procedure codes to determine if a more specific code exists.
• o Supplies cover and pricing information to client Medical Director regarding unlisted codes.
• o Conducts meetings with state client to discuss procedure code coverage and ensures coding decisions are implemented.
• o Responsible for archiving all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.
• o Maintains HIPAA reason and remark code lists and provides code updates to the HIPAA Code Workgroup, when necessary.
• o Supports the Claims Department by working edit reports as assigned.
• o Provides Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment
• o Maintains a library of code books and relevant resources to be available to personnel, when necessary
• o Serves as a resource for the client and co-workers with question related to coding issues.

Requirements

• Must have intermediate/advanced Microsoft Excel skills.
• Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits.
• Must have prior vendor coding review experience.
• Must have the ability to complete chart review production requirements.
• Must be experienced in risk adjustment auditing
• Must possess valid Certified Risk Adjustment Coder credential through AAPC.
• Must have 5+ years of risk adjustment auditing experience with a focus on CMS and HHS RADV reviews.
• Proficient in MS Office Suite o Ability to work independently, with minimal supervision
• Excellent verbal and written communication skills o Ability to abide by policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
• Bachelors Degree or equivalent experience
• 5-7 years in professional coding experience, professional or hospital.
• Knowledge of insurance claims processing.
• CRC (Certified risk adjustment coder certification through AAPC or AHIMA

Skills

Required

• Proficient in MS Office Suite
• Ability to abide by policies

Benefits

• At LanceSoft, full-time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits -
• Four options of Medical Insurance
• Dental and Vision Insurance
• 401k Contributions
• Critical Illness Insurance
• Voluntary Permanent Life Insurance
• Accident Insurance
• Other Employee Perks