Clinical Coder
Pacer Staffing LLC
Date: 3 weeks ago
City: Remote, Remote
Contract type: Full time
Remote
Job Title: Clinical Coder
Location: 100% Remote
Duration: 6+ months (Contract To Hir e)
Shift: 5x8 Hour Shifts, Monday-Friday
Job Summary
Required:
Location: 100% Remote
Duration: 6+ months (Contract To Hir e)
Shift: 5x8 Hour Shifts, Monday-Friday
Job Summary
- Conducts retrospective medical claim reviews and adjudication for coding determinations. Provides coding-related information to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and the claims subcontractor as needed. Serves as the designated recipient for factual network provider claim review requests, develops determination letters, and supports both non-clinical and clinical staff on coding and retrospective medical claims review processes.
- Perform claims coding reviews using current coding guidelines.
- Conduct focused claims reviews as requested by management and summarize findings.
- Identify and report potential fraudulent or quality issues.
- Serve as a resource for staff on ICD-10-CM, HCPCS, and CPT coding.
- Research TRICARE manuals for benefits, limitations, exclusions, and current coding guidelines.
- Monitor and track timeliness of retrospective claims reviews to ensure compliance with required timelines.
- Identify questionable review decisions and escalate to the appropriate Medical Director for evaluation and/or corrective action.
- Provide accurate data entry in medical management and claims systems.
- Perform other duties as assigned.
- Regular and reliable attendance is required.
- Availability to work any shift.
- Works within a standard office environment, with minimal travel.
- Extensive computer work with prolonged sitting.
Required:
- Current Certification as a Professional Coder (CPC) or Certified Professional Coder Hospital (through the American Academy of Professional Coders).
- If supporting TRICARE contract, must be a U.S. Citizen.
- If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
- 2+ years of clinical coding experience.
- 2+ years of claims processing experience.
- Experience in the private medical industry, health insurance, or Managed Care field.
- Experience in a fast-paced corporate environment.
- Familiarity with TRICARE and the military healthcare delivery system.
- Knowledge of ICD-10, HCPCS, and CPT coding.
- Ability to maintain the confidentiality and security requirements of medical records.
- Ability to meet department performance standards.
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