Spherion is recruiting for Medical Coding Consultant-Risk Optimization Clerks for a large, local health care insurance company in Baton Rouge.
The ideal candidate will have 5 years of experience including overseeing chart retrieval processes. This person must also be coding certified. Experience with Diagnostic Accuracy/Risk Adjustment and/or Hedis is preferred.
Conducts and coordinates medical record reviews for Diagnostic Accuracy/Risk Adjustment auditing processes including project coordination and oversight of other coding consultants. Provides written medical coding expert-level responses to internal and external customer requests and third party vendors for clarification of medical coding issues, medical coding policy, regulatory agency policy and coding-related reimbursement and medical policy issues, in a prompt and efficient manner to support medical coding-related activities.
Tracks and reports on the status of medical record review projects. Analyzes results of medical record review projects to assist in provider education to provide guidance on appropriate documentation and coding guidelines.
A minimum of 5 years current hands-on clinical or consultant-level experience with in-depth research, analysis and application of CPT, HCPCS, and ICD-10-CM coding, billing and reimbursement guidelines for Medicare or private payers is required. Strong understanding of CMS and/or HHS Risk Adjustment coding is preferred.
Certified professional coding credentials for CPT, HCPCS, and ICD-10-CM medical coding systems is required.
Strong body of knowledge regarding disease processes and medical and surgical procedures is required. Knowledge and understanding of medical terminology is required. Experience in medical record auditing / review is required.
Extensive experience with provider billing practices, American Medical Association coding guidelines, Correct Coding Initiative edits, Physician Specialty guidelines, payor reimbursement programs, claims adjudication processes, and regulatory agency policies (CMS/HCFA) is required.
Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) is preferred
Strong proficiency with Microsoft Excel and Word is required. Microsoft Access experience is preferred.
Strong project management experience is preferred.
Experience with large scale medical record retrieval is preferred.
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Role: Medical Coding Consultant-Risk Optimization
Location: Baton Rouge,
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