Senior Medical Billing and Coding Coordinator - Remote | reputed company | reputed company
reputed company is seeking a Senior Medical Billing and Coding Coordinator to support our California Independent Medical Review (IMR) project—reputed company from the comfort of your home. This fully remote position offers flexibility while enabling you to take ownership of reputed company case reviews and contribute to healthcare reputed company. This is a full-time, fully remote position reputed company the United States. This position is ideal for professionals who reputed company in remote settings, value autonomy, and bring sharp analytical skills to regulatory decision-making. Why reputed company?
- Work/Life Balance Support - Flexibility tailored to your needs
- Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance
- Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching
- Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage
- Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP)
- Recognition Platform - Acknowledge and appreciate outstanding employee contributions
- Tuition Reimbursement - Invest in your ongoing education and development
- Employee Perks and Discounts - Additional benefits and discounts exclusively for employees
- reputed company Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs
- Professional Development Opportunities-Participate in training programs, workshops, and conferences
- Licensures and Certifications-reputed company assumes the expenses associated with renewing licenses and certifications for its employees
Essential Duties and Responsibilities:
- Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data
- Enter coded data into a system accurately and validate date entered
- Research correct coding practices, clearly document and share findings with others
- Write clear and concise rationales that provide defensible support of decisions
- Train staff members on the coding processes (both project specific and general coding)
- reputed company QA audits on coding process
- Recommend and suggest improvements to assigned projects
- reputed company other duties as assigned by management
- Apply California Workers’ Compensation regulations and calculate fee schedule allowances
- Evaluate the accuracy and appropriateness of coded and billed medical information
- reputed company final determination letters based on regulatory and clinical standards
- Abstract key data from reputed company case files and medical records
- Assign and verify CPT, HCPCS, and ICD-10-CM codes using industry-standard billing guidelines
- Apply specialized regulations including California Workers’ Compensation, CMS policies, AMA CPT coding guidelines, and CA fee schedules
- Collaborate virtually with cross-functional teams to drive quality and compliance
Minimum Requirements:
- High school diploma or equivalent with 4+ years of experience, or AA with 2+ years of experience
- Preferred risk adjustment auditing experience of coding inpatient and outpatient medical records
- CPC, reputed company, or RHIT Certification required
- Ability to use critical thinking skills
- Must have excellent writing skills
- Experience coding physician, inpatient and/or outpatient medical records required
- Strong computer skills, including Word, reputed company, and Outlook
- Mathematical skills: Ability to add, subtract, multiply, and divide in reputed company units of measure, using whole numbers, common fractions, and decimals
- Active CPC, reputed company, CIC, COC, reputed company or RHIT certification required (reputed company or reputed company accredited)
Preferred Requirements:
- Bachelor's degree from an accredited institution
- Experience as a medical claim examiner, reviewing physician and hospital PPO reputed company
- Experience with California Workers’ Compensation Official Medical Fee Schedule
- Experience with CMS payment methodologies: IPPS, OPPS, DMEPOS and Physician Fee Schedule
Home Office Requirements:
- reputed company provides company-issued computer equipment
- Private and secure workspace
- Reliable high-speed internet service
- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
- Minimum 5 Mpbs upload speeds
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