Claim Review Specialist – Facility Coding, Certification Required

🔥 17 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CorroHealth

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

CorroHealth is a leading provider of clinically led healthcare analytics and technology-driven solutions, focused on enhancing the financial performance of hospitals and health systems. Their integrated solutions and advanced technologies aim to optimize the entire revenue cycle, offering services such as revenue cycle management, clinical documentation, medical coding, and denials management. With a commitment to improving financial health through intelligent technology and expert guidance, CorroHealth addresses complex payer-provider relationships and supports efficient healthcare operations.

📋 Description

• Assist the Director of HIM in preparing claim audits • Review and recommend coding, revenue cycle, and charge/billing changes for client hospital outpatient and Profee claims using proprietary software • Develop standardized reports using the software • Meet with clients and respond to coding questions in clear, concise, grammatically correct English • Provide support to other revenue cycle consulting team members • Prepare client education materials and written FAQ answers • Become proficient in the PARA Data Editor proprietary software • Select and review claims based on trends and data analysis; organize medical documentation • Audit charges, OPPS and CAH charges, CMS/payer guidelines, ICD-10-CM and CPT/HCPCS coding, departmental data/documentation, NCCI/MUE edits, Medi-Cal and Medicare guidelines, units of service, E/M Profee/facility coding, and documentation improvement • Assist with written documents for publication, including Q&A entries • Develop understanding of outpatient hospital reimbursement, documentation, coding, and billing • Participate in presentations to clients and prospective clients via web meetings • Maintain specialty knowledge, certifications, and accreditations; research new guidelines, data elements, and payer specifications • Perform other duties as assigned

🎯 Requirements

• Coding certification through AHIMA or AAPC required; CCS, COC, or CPC certification required (CPC-A not accepted) • 5+ years of current, directly related experience in outpatient facility coding • Extensive OP facility coding experience including ED, SDS, I&I, OBS, facility E/M, ancillary, IR, and Profee coding • IP facility coding experience is a plus • Critical Access setting experience is a plus • Medical terminology and anatomy knowledge • Strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines, Official Coding Guidelines, outpatient coding and billing • Knowledge of revenue codes, HCPCS, MUE and CCI/NCCI edits, units of service, and ICD-10-CM • Strong Microsoft Excel, PowerPoint, Word, and OneNote skills • Strong analytical capability, independent thinking, and decision-making • Excellent written and verbal communication and presentation skills • Strong computer and technology knowledge and skills • Highly professional demeanor and client satisfaction skills • Ability to work at a computer terminal for 6–8 hours per day • Ability to lift and move materials weighing up to 20 lbs. when required

🏖️ Benefits

• Professional development and personal growth investment • Work from home office • Remote work arrangement