HYBRID RN - Medical Coder

Job DescriptionJob Description

This is a contract assignment with a high likelihood of extension and a great way to start working with a top-tier healthcare organization!

Note: We have other positions available, if you want to explore more

Shift: 9am- 5pm

Duration: 9 weeks

Location: HYBRID

Scope Of Role & Responsibilities

• We need a clinician to review medical records to validate clinical and coding assessments Medical coding Review medical records and healthcare claims to determine the accuracy and compliance of billed codes with appropriate regulations, standards, policies, and procedures.
• Conduct audits of high-risk claims and billing patterns to ensure adherence to healthcare regulation and Client policy and detect potential FWA.
• Collaborate with other CLIENT team members to evaluate suspected cases of fraudulent activities, such as over-utilization of services, upcoding, and billing for non-medically necessary services.
• Create detailed reports with medical review findings that include research, rationale, sources and corrective action recommendations to the CLIENT Department. The reports will also validate whether audited claims should be denied, recouped and if other mitigation strategies are required.
• Participate as needed on provider calls to discuss findings and rationale of medical review.
• Present findings to leadership and other stakeholders to facilitate all FWA proceedings.
• Assist in preparing documentation for audits, recoupments, compliance/legal reviews and regulatory inquiries.
• Maintain thorough documentation of investigations, including clinical findings, coding discrepancies and all communication with healthcare providers and investigators.
• Stay updated to changes to coding guidelines, healthcare regulations, and fraud detection methods to ensure compliance and effective investigations.
• Completes special projects and audits as required.
  
  

Required Education, Training & Professional Experience

• 5 years of experience in healthcare fraud detection, investigation, or auditing
• In depth experience and knowledge of coding regulations including ICD-10, CPT, HCPCS, AMA etc.
• AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS)
• Bachelor’s degree in Nursing, Medical Billing/Medical Coding, Healthcare or other related fields
• Strong communication skills to interact with providers, medical management, legal teams, and compliance departments.
• Strong analytical, research and problem-solving aptitude with attention to detail and accuracy
• candidate will have experience in Medicaid, Medicare, and Marketplace/Exchange
  
  

Licensure And/or Certification Required

• AAPC Coding certification - Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS) - Required
• Registered Nurse (RN) – Required
  
  

Company DescriptionPride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.Company DescriptionPride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.