Clinical Coder - Outpatient

 Job Title: Clinical Coder - Outpatient
Job ID: 81191
Location: Arizona, USA - Remote

Overview:
Under the direction of the DRG Supervisor or designee, conducts coding review of prior authorization requests for unlisted codes or services; retrospective medical claims review for coding and pricing determinations; and/or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment. Provides coding-related information to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management and the claims subcontractor as needed.. Develops determination letters. Provides support to non-clinical and clinical staff on coding and pricing and retrospective medical claims review processes.


What you will be doing:

• Performs claims coding and pricing reviews using current coding guidelines. 

• Performs focused claims reviews as requested by management and summarizes findings. 

• Identifies and reports potential fraudulent or quality issues. 

• Acts as a resource for company staff on ICD-10-CM, ICD-10 PCS, CPT and HCPCS coding. 

• Researches company manuals for benefits, limitations and exclusions and current coding guidelines to assist with the Referral and Authorization Decision Support tool process 

• Monitors and tracks timeliness of retrospective claims reviews response to ensure compliance with required timelines for completion of assigned reviews. 

• Identifies questionable review decisions and forwards to the Supervisor and/or Medical Director for evaluation and/or corrective action. 

• Provides accurate data entry in the medical management and claim processing system. 

• Performs other duties as assigned. 

• Regular and reliable attendance is required.

What you must have:

• High School Diploma or GED 

• Current Certification as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT) 

• U.S. Citizen 

• Must be able to receive a favorable interim and adjudicated final Department of Defense (DOD) background investigation. 

• Minimum 2 years of clinical coding experience for either outpatient and/or inpatient accounts 

• Minimum 2 years of claims processing experience in outpatient and/or inpatient accounts

Nice to have:

• Experience in the private medical industry, health insurance or Managed Care field 

• Experience in a fast-paced corporate environment 

• Familiarity with the company and the military healthcare delivery system

Salary/Rate Range: $33.50 - $36.00


For more information about TEEMA and to consider other career opportunities, please visit our website at www.teemagroup.com