A client in the greater Nashville, TN area is looking for a 100% REMOTE Medical Coder to join their team and help with their backlog. This resource will need to have experience with both hospital outpatient and physician coding appeals. They will be responsible for conducting coding audits of post adjudicated claims to determine appropriateness of procedure and diagnosing codes billed based on documentation provided for Inpatient and Outpatient facility claims as well as Ambulatory Surgery Centers and Professional claims. They will drafts appeals to payors using national sourced coding guidelines. It is important that they are comfortable recommending potential coding changes if errors are found.
Experience in Hospital Outpatient and Physician based coding appeals
Active certification -- Certified Coder through AAPC or AHIMA
Familiar with using resources such as: Encoder Pro; Find-A-Code; NUBC (National Uniform Billing Committee) Reference; CMS-Medicare; 3M, etc.
Key knowledge concepts:
Billing forms: UB04 and CMS 1500
Coding: CPT; HCPCS; Modifiers; ICD-10-PCS; Condition Codes; Value Codes; Revenue Codes
CMS Medicare-Basic Billing requirements/rules; MS-DRG; Status Indicators; Packaging concepts; Unbundling; NCCI; MUE-Medical Unlikely Edits; Downcoding
Ability to comprehend unique payer data elements required for reimbursement (Ex: Workers' Compensation claims)
Experience with Workers' Compensation, Veterans, Commercial and Out of State Medicaid claim types
CARC and RARC coding experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.