CPC Medical Coding Specialist

Responsibilities

• Sorts and verifies that each claim contains all information required to conduct the review.
• Receives client submissions and inputs client and examinee data in the system database.
• Processes claims by correctly identifying the billing type (physician, surgery center, hospital, etc) and entering medical bills into the reviewing system, allowing automated adjudication to process.
• Reviews each claim and addresses all necessary modifications manually. Including reviewing and applying any applicable coding and/or billing guidelines per industry standards and/or specific client requests.
• Contacts client to resolve questions, inconsistencies, or missing data needed for review.
• Performs quality assurance on every case prior to completion.
• Ensures all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
• Processes client invoicing in accordance with the client’s fee schedule.
• Ensures all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
• Performing quality assurance on various coding related reviews.
• Willing to provide deposition and/or testimony in court for any reports written.
• Perform other duties as assigned.

Qualifications

• Must have current, active coding certification in CPC through AAPC.
• CPMA certification is preferred but not required.
• High school diploma or equivalent required.
• Minimum one year medical billing experience; or equivalent combination of education and experience required.
• Must be able to cross reference different types of billings to ensure consistency in the review process.
• Knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines preferred but not required.
• Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must have a full understanding of HIPAA regulations and compliance.
• Qualified typist with a minimum of 35 W.P.M ideal but not required.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers’ compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer – Minorities/Females/Disabled/Veterans

Tags: CPC, CPMA, RN, Certified Professional Coder, Certified Professional Medical Auditor, Registered Nurse, Medical Coding