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Job Ref.: 4038

Job Title: Certified Coding Specialist

Role: Accounting / Finance / Billing / Collections

Relocation Available: No

Industry: Healthcare

Location: Ohio

Town / City: Cincinnati

Job Type: Permanent full-time

Job description:

Primarily responsible for thorough review of managed care contracts and comparison of such contracts against healthcare claims to identify underpayments for the assigned client.
 
Essential Duties and Responsibilities:
 
Research, communicate and educate others on coding changes that impact reimbursement
Identify areas of opportunity that occur as a result of a coding or billing error
Review insurance contracts to gain thorough understanding of payment methodologies
Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
Prepare and submit correspondence such as letters, emails, faxes, online inquiries, appeals, adjustments, reports and presentations
Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other personnel
Support and direct claims to all departments and client onsite analysts
Build strong, lasting relationships with clients, payors and personnel
Attend client, department and company meetings
Comply with federal and state laws, company and department policies and procedures
 
Essential Skills and Experience:
 
Minimum 2-years of experience working with hospital claims in some capacity
Familiarity with hospital billing guidelines and requirements
Knowledge of healthcare codes including CPT, HCPCS, ICD-9, ICD-10, DRG and ability to correctly use and apply codes in an operational setting
Ability to read and interpret an extensive variety of documents such as contracts, claims, medical records, EOB's, policies and procedures in written (English) and diagram form
Familiarity with CDM and its impact on reimbursement
High School diploma or equivalent
Ability to define problems, collect data, establish facts and draw valid conclusions
Strong organization and time management skills
Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
Mathematical skills:  ability to calculate rates using addition, subtraction, multiplication and division
Strong customer service orientation
Excellent interpersonal and communication skills
Strong team player
Commitment to company values
 
Non-Essential Skills and Experience:
 
Related Professional License/Certification(s)
Associate or Bachelor's Degree(s)

Bottom Line Requirements:

1.  Certified Coding Specialist (CCS), Registered Health Information Analyst (RHIA), Registered Health Information Technician (RHIT).
2.  2+ years of experience working with hospital claims.
3.  Experience with healthcare codes including CPT, HCPCS, ICD-9, ICD-10, DRG.
4.  Local or close enough for a short easy move.

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