Senior Medical Coding Specialist

Job Description:

The Senior Medical Coding Specialist will advocate and support our team in providing data-fueled solutions that help our clients improve the U.S. healthcare system. We expect the specialist to have strong knowledge and experience with medical professional coding, facility, physician and ancillary billing, and provider reimbursement mechanisms. The successful candidate will assist in the researching of coding and billing rules and guidelines as well as the creation of documentation for machine learning models.

Responsibilities:

• Claim data analysis to identify anomalies.
• Audit medical record documentation to identify incorrectly reported services, procedures, ICD-10, HCPCS, CPT-4 codes, DRG and OPPS.
• In coordination with our data science teams, assist in designing and deployment of continuous improvement programs.
• Assist in the development and validation of the payment integrity machine learning models. These advanced computational models are responsible for the identification of claims payment anomalies, coding errors, contract misinterpretations, or internal processing payment errors.
• Participate in brainstorming sessions, finalization, and creation of presentation of client-specific solution recommendations.
• Document and communicate results of validation to clients and perform necessary follow-up.

Qualifications:

• Minimum of five years experience in the areas of medical coding and provider audit is required.
• Professional Coding certification by the American Academy of Professional Coders or the American Health Information Management Association.
• Coding experience in a Health Care system is required.
• Extensive knowledge of medical claim edits is required
• Hands-on knowledge of physician and hospital reimbursement methodologies including Medicare, Medicaid, and commercial coding practices is required
• Strong written and verbal communication skills
• Strong knowledge of Microsoft Office products is required
• Knowledge of Redshift and SQL is desired
• Bachelor’s degree in a health related field or quantitative discipline is desired.
• RN/LVN is preferred

Eligibility:

• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Must be able to obtain and maintain the required federal public trust clearance for this role

Compensation:

Salary for this position is determined by various factors, including but not limited to, location, the candidate’s particular combination of knowledge, skills, competencies and experience, as well as contract specific affordability and organizational requirements. The proposed salary range for this position is outlined below.

Salary range: $65,000-$75,000

Blue Water Thinking offers a comprehensive benefits package including health insurance (medical, dental and vision), paid time off, federal holidays, and matching 401K plan.