Job Summary:

The Benefits Coding Specialist is responsible for determining action steps and calculations necessary to make an accurate payment. This includes but is not limited to; COB, high dollar, dialysis, DME, Behavioral Health, hospital exclusions, and claim adjustments in an accurate and expedient manner.

Job Responsibilities (but not limited to):

• Responsible for assigning and configuring correct codes on the system to describe the type of service received on patient claims.
• Assign codes for reimbursements; research and is compliant with regulatory requirements utilizing guidelines.
• Assign diagnosis and procedure codes for clinic visits and surgical procedures/deliveries -Interact with other team members to assist with inquiries regarding coding, documentation, denials, and billing.
• Ensure codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Receive and review patients’ charts and documents for verification and accuracy.
• Collect information made by the Physician from different sources to prepare monthly reports.
• Implement strategic procedures and choose strategies and evaluation methods that provide correct results.
• Maintain communication with Management and Providers to ensure timely notification of identified documentation issues.
• Comply with medical coding guidelines and policies.
• Research and analyze data needs for reimbursement.
• Review and verify documentation to support diagnoses, procedures, and treatment results.
• Identify diagnostic and procedural information.
• Research, analyze, recommend, and facilitate plan of action to correct discrepancies and prevent future coding errors.
• Serve as resource and subject matter expert to other coding staff.
• Review provider documentation for coding appropriateness and accuracy.
• Responsible for training the team on processing complex medical claims.

Qualifications:

Education and/or Training:

• Bachelor's degree required or relevant experience in claims/customer service with Medicare Claims and Benefits Coding.

Professional Experience:

• 2+ years of work experience as a medical coder.

Licenses/Certifications:

• CPC (Certified Professional Coder), preferred.

Specialized Skills:

• Medicare/Medicaid experience, preferred.
• Understanding of healthcare industry is required.
• Well versed with CPT, ICD-10 and HCPCS codes.
• Deep understanding and processing of CMS1500 and CMS1450 (UBO4).
• Advanced verbal and written skills.

Technical Skills:

• Strong PC skills; MS Word, Excel, Access, and Power Point.

Additional Considerations:

• Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy.