Reviewing patients' medical records to identify diagnoses and procedures performed. Assigning accurate medical codes for diagnoses, treatments, and procedures according to the appropriate classification system. In addition to abstracting diagnosis codes, the Clinical Review Specialist also audits medical records and validates entries that have been submitted to CMS.
RESPONSIBILITIES:
•Conducts audits of medical records (paper, EMR, hybrid)
•Adheres to compliance of Medicare, Medicaid, and Commercial risk adjustment guidelines with precision.
•Understands, respects, and applies client specific guidelines
•Adheres to audit and medical record review schedules to meet client expectations and government-regulated deadlines
•Regularly participates in peer review; provide and receive feedback
•Ensures accurate documentation to support all audits
•Assures adherence to and currency with internal and external regulatory guidelines:
•CMS/HHS
•DOH
•HIPAA, HITECH, and Fraud Waste & Abuse
•Medical coding protocols
•Maintain coding credentials as required by credentialing agency
REQUIREMENTS:
•Coding Certification: CPC, CCS, CRC, RHIT, or RHIA
•Possess at least 5 years of experience of with ICD-10, CPT and HCPC coding systems
•Proficiency in MS Office tools such as Word, PPT, Excel and be comfortable learning and becoming an expert on new and proprietary software
PREFERRED QUALIFICATIONS:
•Have strong written and verbal communication skills, including propensity to establish and build strong relationships.
•Take initiative to establish priorities, coordinate work activities and perform multiple and complex tasks while working independently and with minimal supervision in a remote setting.
•Ability to consistently meet established minimum quality standards in a heavy production environment
•Must be able to meet organization production and accuracy goals
•CRC Certification
Job Type: Full-time
Pay: $25.00 - $28.00 per hour
Expected hours: 8 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
Work setting:
Experience:
- ICD-10, CPT and HCPC coding systems: 5 years (Required)
- RHIT or cpc or CCS certificate: 5 years (Required)
- Medical coding: 5 years (Required)
- HCC coding: 3 years (Required)
- Risk Adjustment: 2 years (Required)
Work Location: Remote