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Medical Coder
Ref No.: 17-03424
Location: New York, New York
Title: Coding SpecialistMedical Coder
Duration: Contract to hire
Location: Midtown NYC

Reviews and audits claims for billing, coding, services and other compliance or reimbursement issues. Assists with non-clinical aspects of the claims review process and benefit design/coding . Supports and educates other departments to provide an enterprise level solution for the resolution of claims and benefit design/coding. Applies coding skills to various initiatives to ensure claims payment integrity.  Works under moderate supervision.
Reviews medical claims, records and other requested information for billing, coding and other compliance or reimbursement related issues; makes payment determination recommendations.
Investigates and gathers information necessary to determine payment of claims and to respond to appeals, utilizing administrative policies, regulatory codes, legislative directives, precedent or other guidelines.
Collaborates with Product Managers on creating testing scneraios and assisting in testing in Facets.
Maintains benefits grids with the assistance of management, provides clinical and/or non-clinical guidance on use of grids.
Reviews coding disputes that come in via claim appeal/dispute, which includes review of all supporting documentation, review of old and new procedure codes, and consultation with Medical Management, Grievance and Appeal Unit, Medical Director, Provider Relations, and Contracting, as necessary.  Recommends payment or denial of appeal based on review.  Prepares responses to appeals.
Prepares requests for configuration changes based on audit and claims reviews to ensure that configuration mirrors provider contract.
Collaborates with Compliance to develop internal protocols; reviews for provider Fraud and Abuse.
Works closely with Medical Director and Medical management staff on authorization guidelines for all company's benefits.
Prepares correspondence and summary reports of coding review, claims review and appeals. Maintains databases and files as necessary.
Assists with training and guidance to Claims staff on coding.
Keeps current on new coding and billing guidelines and federal and state initiatives regarding claims.  Educates other departments on new/changes to regulations. 
Coordinates recoupment efforts with Provider Relations/Finance that are the result of billing errors and overpayments. Responds to provider inquiries regarding recoupments.
Performs department and external quality audits.
Participates in special projects and performs other duties as required.
Licensure:  Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) in ICD-10-CM coding required.
Education:   Bachelor's Degree or the equivalent work  experience required.
Experience:  Minimum tthree years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems, required.  Experience working with claims policy and contract implementation required.  Proficient with personal computers required. Knowledge of Federal and State Medicaid guidelines, managed care programs, practices and regulations required.  Demonstrated proficiency with the principles and methodologies of process improvement required.