Medical Coding Reviewer I Exception Template

Summary:

• Location: 100% Remote - Will work in CST time zone
• Shift: 8 am to 5 pm CST
• Duration: 6 months, potential to extend
• Perform clinical/coding medical claim review to ensure compliance with coding practices.

Responsibilities:

• Support quality and compliance through correct coding and policy adherence claim and medical record reviews.
• Report for assignment by logging into the system remotely and start to work.
• Work from a work queue that auto selects the next highest priority claim/medical record review needed.
• Record productivity into the production tracking application.
• Take breaks and lunch as required.
• Communicate with the assigned leader if assistance is needed with work.
• Submit a ticket to the Training team for support if beyond the training ramp-up period.
• Communicate changes to the current work process through various methods.
• Participate in audits and receive education as needed to reduce future errors.
• Reach and maintain production at 100% and quality at ≥ 95%.

Requirements:

• Associate’s degree in a related field or equivalent experience.
• Coding Certification - CPC, CPC-H, CPC-A, CPC-P, CCS, CCS-P, CPMA, RHIT, or RHIA.
• 2 years of experience in medical billing & coding.

Required Skills:

• Analyze provider billing practices using code auditing software, provider documentation, administrative policies, regulatory codes, legislative directives, precedent, AMA, and CMS code edit criteria.
• Identify potential billing errors, abuse, and fraud.
• Operate technological hardware (laptop, PC) and work in software applications.
• Written and verbal communication.

Preferred Skills:

• Experience in provider communication and education.
• Positive attitude, growth mindset, and ability to work well with change.
• Partnership approach and critical thinking.