Job description

Summary

Reviews medical documentation to perform a variety of coding validations for multiple lines of business under Medicare to determine accuracy of billing and payment. Reassigns and sequences diagnostic and procedural codes using universally recognized coding system as appropriate. Compiles and analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare payments.

Description

Logistics:

Work hours will be 8:00 am to 5:00 pm Monday through Friday.
Work from home position. You must have high-speed (non-satellite) internet service and a private home office to work from home.

What You’ll Do:

Determines methodology to identify cases for DRG, HIPPS, HCPCS, RUG, and APC validation. Conducts targeted coding, documentation reviews, and validation reviews coordinating rate adjustments and adjudication of corresponding claims. Utilizes Grouper, Rover, MDS QC tool or other appropriate software for code validation.
Compiles/analyzes statistics to determine focus areas for targeted medical review activities where there is the greatest potential for inappropriate Medicare/TRICARE payments demonstrating records reviewed, outcomes, trends, and savings. Notes deficiencies and makes recommendations to management and others as appropriate/requested. May complete appropriate paperwork/documentation regarding claim/encounter information to correct deficiencies.
Provides coding guidance to clinical review staff. Develops necessary training or reference materials for review staff.
Consults with appeals, provider outreach and education and other supported areas of division as needed as a resource for medical records and coding issues.

To Qualify for This Position, You’ll Need:

Required Licenses and Certificates: Certified Coding Specialist (CCS) OR Certified Professional Coder (CPC) OR Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)
Required Education: Associates in a job-related field OR graduate of Accredited School of Nursing or successful completion of examination offered by American Health Information Management Association (AHIMA) or Academy of Professional Coders (AAPC)
Required Work Experience: One year either ICD-9, DRG, APC, HIPPS, HCPCS, or RUG coding and validation; OR two years: one-year clinical experience and one-year in either DRG, APC, HIPPS, HCPCS, or RUG coding and validation.
Required Skills and Abilities: Working knowledge of word processing software. Knowledge/understanding of medical terminology and medical coding. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.

We Prefer That You Have:

Work Experience: Two years of medical coding experience.
Education: Associate Degree in Nursing or bachelor's degree in health information management.
Software and Tools: Ability to navigate between multiple windows-based programs. Intermediate experience with Excel, Outlook, Access and word processing programs.
Preferred skills: Knowledge of CMS guidelines and Medicare Part B. Knowledge/understanding of Medicare billing process. Working knowledge of spreadsheet and database software.

What We Can Do for You:

Our comprehensive benefits package includes:

401(k) retirement savings plan with company match
Subsidized health plans and free vision coverage
Life insurance
Paid annual leave — the longer you work here, the more you earn
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness programs and a healthy lifestyle premium discount
Tuition assistance
Service recognition

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication. Management will be conducting interviews with the most qualified candidates.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.