USRN Medical Coder (Hybrid)

• Valid USRN license (Mainland US only) - must be valid 6 months after the start date
• Valid medical coding license (Any 1 of the following: CDIP-AHIMA, CPC, CCS (AHIMA) - IP/OP, CIC from AAPC, RHIT/RHIA, or CCDS)
• At least 2 years of bedside experience
• At least 1 year of Inpatient OR Outpatient Coding experience

Job Description:

• Conducts thorough analysis and audits of claims by seamlessly integrating medical chart coding principles, clinical guidelines, and an objective approach to ensure precise medical audit activities.
• Leverages advanced ICD-10 coding expertise, deep clinical guideline knowledge, and industry insights to confidently support audit conclusions.
• Utilizes cutting-edge audit tools, streamlined auditing workflow systems, and comprehensive reference materials to deliver accurate audit determinations and craft detailed audit findings letters.
• Consistently upholds the highest standards of accuracy and quality, in line with audit management expectations.
• Detects potential documentation and coding discrepancies by identifying unusual coding and documentation patterns, including inappropriate billing for readmissions, inpatient admission statuses, and Hospital-Acquired Conditions (HACs).
• Proactively recommends and develops impactful, high-value concepts and process improvements aimed at boosting efficiency and quality.
• Brings a wide range of experience in clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology—preferred skills that help make audits more effective.