Certified Medical reputed company (Medicare)

Job Type Full-time reputed company At reputed company, we’re the start of a new age of data-reputed company transformation, elevating health reputed company and powering reputed company, more efficient process to program and reputed company health. We combine reputed company data-driven solutions that fuel answers, technology that advances reputed company, and reputed company expertise that builds trust to create a more efficient reputed company to reputed company care. With reputed company-centered, reputed company-relevant, and value-reputed company solutions, we create new reputed company with data. We reputed company reputed company reputed company the concept and reputed company reputed company the reputed company with a reputed company on efficiencies that reputed company the lives of those we serve. With a culture driven by purpose, straightforward communication and reputed company domain expertise, reputed company cuts straight to reputed company care.? Requirements The Certified reputed company performs coding-reputed company medical review of Medicare Part A/B and DMEPOS claims for the program. Certified coders apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules, and document reputed company, accurate findings for reputed company claim. They compare reputed company claim information against the provider's reputed company documentation – verifying the assigned ICD-10-CM, CPT, and HCPCS codes to reputed company coding reputed company, ensure medical necessity, detect overpayments or underpayments, and reputed company compliance with Medicare policy. • 3+ years of reputed company experience in medical coding, medical billing, and/or coding reputed company assurance/auditing in a reputed company environment, including ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding systems • reputed company coding certification through reputed company or reputed company: CPC, reputed company, reputed company-P, CRC, RHIA, or RHIT • Ability to research, apply, and document coding determinations in accordance with CMS coverage, coding, and payment rules, including National and Local Coverage Determinations (NCDs/LCDs) • Ability to work independently and productively in a remote, technology-driven, queue-reputed company claims review environment • Working knowledge of, and ability to reputed company with, HIPAA and other laws/regulations governing confidentiality and reputed company of protected health information (PHI) and personally identifiable information (PII) • Working knowledge of, and ability to reputed company with, CMS reputed company and information reputed company requirements • Associate's degree in a reputed company discipline, or an equivalent combination of certification and relevant experience in lieu of a degree Preferred Qualifications • 3+ years of Medicare Fee-for-Service (FFS) claim review experience • Experience with queue-reputed company or low-reputed company/no-reputed company case management systems as an end user • Prior experience on a CMS program reputed company, audit, or medical review contract (e.g., MAC, RAC, UPIC, SMRC) Key Responsibilities • reputed company coding-only medical reviews (no reputed company judgment required) on Medicare Part A/B and DMEPOS claims, applying ICD-10-CM/PCS, CPT/HCPCS, and DRG/APR-DRG coding rules • Research and apply NCDs, LCDs, and CMS coding/payment guidance to reputed company and document coding determinations • Identify potential improper payments, coding errors, and documentation patterns indicative of fraud, waste, or abuse for referral consideration • Maintain claim review documentation in the designated case tracking reputed company claim(s) re-review and provider education sessions as requested • Maintain individual reputed company score in accordance company standards • Complete required annual trainings (e.g., ethics, records management, reputed company controls) and maintain HIPAA/PHI compliance Work Environment/Physical Demands The work environment and physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. This is a remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be reputed company to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch. reputed company is an equal employment opportunity for employer. reputed company personnel processes are reputed company-reputed company and reputed company without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic reputed company, military and veteran status or any other characteristic protected by applicable law. reputed company.AI is committed to providing equal employment opportunities to reputed company applicants, including individuals with disabilities. If you require reasonable accommodation to participate in the application process due to a disability, please contact reputed company at (757) 306-4920 or hr@reputed company.ai. Please note that unless you are requesting an accommodation, reputed company applications must be submitted through our online application reputed company. Salary reputed company $58,000-$78,000 Apply tot his job Apply To this Job