Claim Review Specialist - Facility Coding - Certification Required

📋 Description

• Review outpatient hospital and professional-fee claims using proprietary software, data trends, and
• Conduct comprehensive claim audits covering omitted or incorrect charges, coding accuracy
• Apply OPPS, Critical Access Hospital, CMS, Medicare, Medicaid, Medi-Cal, payer-specific, NCCI, and
• Evaluate ICD-10-CM, CPT, and HCPCS coding, including facility E/M, emergency department, same-day
• Identify coding, charge, billing, and documentation improvement opportunities and recommend
• Become proficient in the organization's proprietary claim-review and data-analysis software and use

🎯 Requirements

• 5+ years of current, directly relevant experience in outpatient facility coding.
• Current CCS, COC, or CPC certification through AHIMA or AAPC is required
• Extensive expertise in outpatient facility coding, including emergency department, same-day
• Strong knowledge of revenue cycle processes, outpatient coding and billing, CMS guidelines
• Working knowledge of ICD-10-CM, CPT, HCPCS, revenue codes, NCCI/CCI edits, MUEs, units of service
• Strong understanding of medical terminology, anatomy, clinical documentation, and coding guidelines.

🎁 Benefits

• Fully remote, work-from-home position within the United States.
• Full-time, exempt employment.
• Opportunity to work on healthcare revenue cycle, coding, reimbursement, and audit initiatives with
• Professional development opportunities and continued exposure to evolving coding, reimbursement
• Opportunity to expand expertise into inpatient coding and broader revenue cycle consulting.
• Collaborative environment combining clinical expertise, analytics, technology, and client