Job ID: 9990

  • Nov 9, 2020
  • Picadilly Star - Bonifacio Global City

The Coding Analyst possesses a solid understanding of CPT Coding and CMS rules and regulations along with excellent writing and computer skills. This position frequently researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. They also use internal business rules to prepare written documentation of findings through medical record review. The Coding Analyst possesses an overall understanding of all coding principles, including facility, provider and DME type coding and provide health care payers with a total claims management solution. Typically, 90% of a Coding Analyst’s time is spent performing coding and documentation review and 10% spent performing other tasks as assigned. Position Description The Payment Integrity Coding Analyst researches and interprets healthcare correct coding using regulatory requirements and guidance related to CMS, CPT/AMA and other major payer policies. They also use internal business rules to prepare written documentation of findings through medical record review. The Coding Analyst possesses an overall understanding of all coding principles, including facility, provider and DME type coding and provide health care payers with a total claims management solution.

Primary Duties/Responsibility 1: Process and/or review claims in a timely manner utilizing client specific coding and billing requirements that meet or exceed production and quality goals 20%

Primary Duties/Responsibility 2: Documents coding review findings within investigative case tracking system and maintains thorough and objective documentation of findings 20%

Primary Duties/Responsibility 3: Analyze medical documents to evaluate potential issues of fraud and abuse 10% Primary Duties/Responsibility 4: Monitors, tracks and reports on all case work. 10%

Primary Duties/Responsibility 5: Communicates determinations verbally and/or in writing to appropriate business department as required by department internal workflow policies 10%

Primary Duties/Responsibility 6: Identifies and recommends opportunities for cost savings and improving outcomes 10%

Primary Duties/Responsibility 7: Monitor CMS and major payer coding and reimbursement policies 10%

Primary Duties/Responsibility 8: Researches and interpret correct coding guidelines and internal business rules to respond to customer inquiries 10%

Coordinate activities with varying levels of leadership, investigative team, legal counsel, internal and external customers, law enforcement and regulatory agencies, and medical professionals through effective verbal and written communications.

  • Excellent communication skills both verbal and written with a high attention to detail.
  • Proficiency in navigating various computer applications with the ability to ramp up quickly.
  • Understanding of Microsoft products including Outlook, Excel and Word.
  • Ability to learn and navigate multiple computer programs quickly and effectively.
  • Proven ability to review, analyze, and research coding issues.
  • 4+ years of hospital and physician medical claims experience.
  • Reimbursement policy and/or claims software analyst experience (Desired).
Serves as a coding resource and provides coding expertise and guidance to entire investigation and/or clinical team. Participates in process improvement activities and encourages ownership of and group participation in improvement initiatives

Minimum Qualifications:

  • Graduate, BS Nursing (Registered Nurse Required)
  • 3+ years’ experience in coding with primary focus in facility and pro fee coding

  • Nationally recognized coding credential required: RHIA, RHIT, CCS-P, or CPC

  • Knowledge of claims editing software and rules development (Desired).
  • Must be available to work full-time, Monday-Friday (time to be determined).
  • Ability to establish good customer relationships with trust and respect.
  • Good interpersonal skills

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.