Claims Review Coder (CPC or CCS-P)

Location: San Leandro, CA
Date Posted: 08-01-2018
Claims Review Coder
San Leandro, CA
*** Full Time position that requires all employees be in office / on site.  ***

Claims Review Coder Job Summary:
  • Review claims and related documents for appropriate adjudication that focuses on proper use of codes and applicable coding edits;
  • Review processed claims to ensure compliance with policies and regulatory requirements or standards.
  • Review of CCS reports for accuracy.
  • Work with Coding Specialist to resolve coding related disputes
  • Make sound judgment on claim disputes that ensures compliance with policies, government regulations and ICE standards, i.e. Ab1455, HIPAA, etc.
  • Provide coding education and guidance to internal claim staff, clinic providers and billing staff.
  • On a regular basis, review Medicare Bulletins for new or updated policies and benefits that may impact claim operations.
Claims Review Coder Background:
  • High School diploma or equivalent; Associate or Bachelor degrees are a plus.
  • Requires Certified Coding Specialist-Physician (CCS-P) or Certified Professional Coder (CPC).
  • At least 3-4 years of medical coding / claims review experience.
  • Proficient in CPT and ICD-9/ICD-10 coding.
  • Knowledge of medical terminology
  • Knowledge of insurance and coding guideline procedures
  • Ability to provide constructive feedback on claims processed to Claims Staff
  • Ability to make decisions and take action based on high level goals.
  • Ability to prioritize multiple projects and maintain deadlines.
  • Excellent written and verbal communication skills, to allow for effective communication at any level
623.201.8732 (CALL – TEXT – FAX)
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