Role Overview
The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. This role requires awareness of international coding systems and healthcare billing practices to support global operations and ensure alignment with international regulatory standards.
What You Will Do
Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; apply recommendation of national coding and international coding and regulation standards to claims billed; prepare clear, concise and legible findings, including documentation that may be used in cross-border audits or international compliance reviews.
Why It Might Be a Fit
This position requires excellent communication, teamwork, training, presentation, negotiation and organizational skills, including cross-cultural communication. The ideal candidate will have knowledge of inpatient/outpatient hospital billing requirements, professional claim billing requirements, payer reimbursement policies, state and federal regulations, international healthcare systems, and global medical necessity criteria.
Requirements
- Minimum completion of educational curriculum required of medical license or coding certification held with Bachelor's Degree preferred; or minimum Bachelor's Degree in healthcare related field and at least 2 years of coding experience.
- Current nursing certification and/or current certified coder (CCS, CCS-P or CPC), Registered Health Information Technician (RHIA/RHIT).
- Minimum 2 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
- Knowledge of inpatient/outpatient hospital billing requirements including UB-04s, revenue codes, CPT, HCPCS, ICD-9/10, DRG, APCs, and familiarity with international equivalents (e.g., KSA, ICD-10-AM, ACHI, CCI).
- Knowledge of professional claim billing requirements including HCFA-1500s, CPT codes and ICD-9/ICD-10 diagnoses codes, as well as international claim forms.
- Knowledge of payer reimbursement policies, state and federal regulations, international healthcare systems, and global medical necessity criteria.
- Familiarity with international medical data resources and coding tools.
- Auditing and health information management experience in a healthcare setting preferred.
- Excellent communication (verbal and written), teamwork, training, presentation, negotiation and organizational skills, including cross-cultural communication.
- Proficiency in MS Office Suite and database software; experience with international billing platforms is a plus.
- Ability to handle multiple tasks in a fast paced environment.
- Ability to read and abstract medical records.
- Knowledge of medical terminology, anatomy, and physiology.
- Ability to interact and discuss audit results with providers.
- Required licensures, professional certifications, and/or Board certifications as applicable.
Benefits
- Medical, dental and vision coverage with low deductible & copay
- Life insurance
- Short and long-term disability
- Paid Parental Leave
- 401(k) + match
- Employee Stock Purchase Plan
- Generous Paid Time Off – accrued based on years of service
- 10 paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits
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