Medical Coder

Great Hill Solutions is part of the Seneca Nation Group (SNG) portfolio of companies. SNG is the federal government contracting business wholly owned by the Seneca Nation. SNG meets mission-critical needs of federal civilian, defense, and intelligence community customers across a variety of domains. The SNG portfolio receives shared services support from its parent company Seneca Holdings and is comprised of multiple companies that participate in the Small Business Administration 8(a) program. To learn more visit www.senecanationgroup.com and follow us on LinkedIn.

The Seneca Nation Group companies offer competitive compensation and a strong benefits package including comprehensive medical and dental care, matching 401K, paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection for you and your family. We pride ourselves on our collaborative work environment and culture which embraces our mission of providing financial and non-financial benefits back to the members of the Seneca Nation.

Great Hill is seeking a team of Medical Coders to support our DHA client. 

Roles and Responsibilities include but are not limited to: 

• Support the DHA-project with extensive SME (Subject Matter Expert) knowledge in Military Health System (MHS) GENESIS Revenue Cycle billing and coding regulations and payer guidelines 

• Maintain knowledge of various healthcare insurance programs (MEDICARE, commercial carriers etc.). 

• Review and resolve claims with coding/billing errors (e.g., coding mistakes, medical necessity issues). 

• Analyze clinical documentation to ensure accurate coding (ICD-10, CPT, HCPCS). 

• Analyze and reconcile Discharged Not Final Billed (DNFB) and various types of suspended charges.  

• Apply principles and practices in Revenue Cycle management, such as charge capture, coding, billing, reimbursement, denial management, and compliance. 

• Training support/collaboration on end user training materials and workflow collateral 

 
Basic Requirements: 

• Requires a Bachelor’s degree in a clinical or healthcare-related field. An Associate’s degree combined with an additional five (5) years of Revenue Cycle experience may be substituted for the Bachelor’s degree. 

• Can achieve a Favorable Suitability Adjudication, based on a T1 background investigation. 
   
• Experience with ICD-10, ICD-10 PCS, CPT, HCPCS Level II coding, LCDs, and NCDs. 

• Knowledge of MHS, UB-04, HCFA 1500 billing, both professional and facility billing, coding policy reports and regulations. 

• Expertise in determining medical necessity based on documentation. 

• Ability to abstract and code from documentation all diagnoses, procedures, inpatient and outpatient services accurately. 

• Understanding of coding bundling rules and regulations. 

• Knowledge and a working understanding of Revenue Cycle concepts, business processes, and/or operations within the healthcare industry. 

• Ability to collaborate and communicate effectively with team members, clients, business partners, and other various stakeholders involved in the Revenue Cycle. 

• Microsoft Office 365 proficiency (Excel, Word, PowerPoint). 
• Excellent oral, written, and interpersonal skills.
   

Desired Qualifications: 

• Must have a Favorable Suitability Adjudication, based on a current T1 background investigation. 

• Possess a DHA issued Common Access Card (CAC) 

• Substantial experience within the MHS environment and requisite knowledge of Revenue Cycle operations. 

• Experience with the Oracle/Cerner Electronic Health Record (EHR) (MHS GENESIS), and reports: HealtheAnalytics, Discern Reporting Portal, and Lights On Network, ideally in the MHS environment. 

• MHS MTF medical billing and auditing experience. 

• Ability to use various software applications and tools to perform Revenue Cycle functions, such as the Oracle/Cerner Patient Accounting Module (CPAM)), billing/claim solutions/systems (Electronic Claims Clearinghouse (SSI), 3M 360 Encompass Institutional & Professional Coding, Claim Scrubber Edits (Alpha ii), Dentrix Billing, Patient Statements/Letters (RevSpring)), and data analytics tools/repositories (Excel, Power BI, SAS, Tableau, Healthe Analytics). 

• Experience in the following MHS GENESIS roles: CPA: Accounting/Biller/Poster, CPA: Management, CS: Charge Analyst Local, and Scheduling Basic.