Medical Review Coder Specialist, Medicare

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Empower AI

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1989

🎖️ Defense

🏥 Healthcare

📦 Logistics

Defense • Healthcare • Logistics

Empower AI, formerly known as NCI, is a company that enhances the capabilities of public sector teams through advanced artificial intelligence solutions. With a focus on federal agencies, Empower AI leverages its extensive technical expertise to address complex challenges in both Civilian and Defense missions, enabling government leaders to boost workforce productivity and make informed decisions quickly. The company's offerings encompass a range of specialties, including AI, cybersecurity, software development, and cloud migration, aimed at facilitating meaningful transformation within government operations.

📋 Description

• Review and analyze sampled Medicare claims with associated medical records • Make payment determinations based on coding and practice guidelines • Make coding determinations using AHA Coding Clinic resources and AMA CPT Assistant • Validate ICD-10-CM, ICD-10-PCS, CPT-4, and HCPCS II coding and MS-DRG assignments on acute inpatient and outpatient claims • Review diseases, conditions, procedures, and clinical documentation to ensure codes are supported • Conduct in-depth claims analysis using ICD-10-CM, CPT-4, and HCPCS Level II coding principles • Use electronic health information imaging and an electronic database module to enter coding review decisions • Use internet and intranet sources for policy verification • Use Microsoft Office and software templates for claims review • Meet quality and production standards • Ensure departmental compliance with the quality management system and ISO requirements

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience • Active Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) • Preferred additional certification: CCS-P, CPC, COC, RHIA, or RHIT • Minimum four years of experience in inpatient, acute care coding for Medicare reimbursement • Experience with MS-DRG assignment and encoders • Ability to maintain strict confidentiality of sensitive material • ICD-10-CM/PCS coding experience • Ability to meet home-office security requirements if approved for remote location • Must pass a coding test before hiring in Part A DRG Medicare inpatient MS-DRG • Ability to sit for long periods

🏖️ Benefits

• Military-friendly employer recognition and support for active-duty and veteran employees • Remote work arrangement if approved • Home-office security requirements support for the remote location