Ardelle Associates is seeking a MedicalCoder to support the United States Attorney's Office in Newark, NJ.
- Examines, views, searches, analyzes, and synthesizes documents, information, and claims and billing data (e.g., ICD-9, ICD-10, CPT, and HCPCS codes) contained in Medicare and Medicaid databases, private insurance databases, regulatory databases, and open sources.
- Performs medical reviews of claims data and medical records in a post-payment environment to analyze and identify potential fraud, waste, and abuse.
- Conducts data mining and data analysis techniques utilizing claims data to detect aberrancies and outliers and develop trends and patterns for potential cases.
- Reviews, summarizes, and organizes a variety of documents, including claims documents, medical records, and highly technical medical, pharmaceutical, and other scientific documents.
- Reviews incoming material from various sources, including pharmacies, medical practices, doctors, hospitals, drug manufacturers and distributors, and various related industry-specific contractors and entities. Organizes such materials according to custodian and category, and compares such items to data sets to identify and prove trends in fraudulent billing and claims practices. Collaborates with law enforcement agencies, or other sources to identify necessary documentation and leads. In preparation of documents and all other tasks, considers the nature and the status of the case involved.
- Assist with interviews of and meetings with law enforcement agents and investigators, potential witnesses, and attorneys to assist during the course of the investigation, charging, and in advance of trial and at court appearances. Reviews and summarizes data sets to assist the AUSA in investigations, and in preparation for charging or trial.
- 3 Years medical coding experience
- 2+ years working with and reviewing highly complicated and highly technical and/or scientific data and documents, including medical records, medical claims data, information pertaining to pharmaceuticals and pharmaceutical companies, and pharmacy records.
- Prior experience, training, education or knowledge with or in the areas of medicine, medical practices, health care professionals, pharmaceuticals, pharmacies and/or pharmacy operations will be highly useful.
- Must have one fo the following certifications or degrees: Associate's degree in Health Care; Bachelor's degree in Health Care Administration, Public Health, or Fraud Forensics; RNILPN (Registered Nurse/License Practical Nurse); CPC (Certified Professional Coder), COC (Certified Outpatient Coder), CIC-H (Certified Inpatient Coder); CRC (Certified Risk Adjustment Coder); RHIT (Registered Health Information Technician); certification related to Medicare claims processing.
- Paid Health Care
- Paid Federal Holidays
- Paid Leave
- Paid Sick Leave
Job Types: Full-time, Contract
Ardelle Associates Inc. is a legal/financial support services company.
Role: Medical Coder
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