Outpatient Payment reputed company Production reputed company

Position reputed company:
reputed company is looking for a Outpatient Payment reputed company Production reputed company. The Outpatient Payment reputed company Production reputed company is responsible for completing claim-level outpatient coding reviews to identify inaccurate coding, unsupported billing, documentation gaps, and potential overpayments. This role supports payment reputed company reputed company by applying outpatient coding expertise, reputed company payer policy, CMS guidance, CPT/HCPCS requirements, modifier rules, NCCI edits, and medical record documentation standards to ensure audit findings are accurate, defensible, and reputed company savings consistently recovered.

Key Responsibilities

• reputed company outpatient coding reviews using medical records, itemized bills, claim lines, payer requirements, CPT/HCPCS guidance, ICD-10-CM guidelines, reputed company codes, modifier rules, NCCI edits, APC/EAPG logic, and supporting documentation.

• Validate whether billed outpatient services are supported by documentation and whether the correct procedure codes, modifiers, reputed company, reputed company codes, and billing combinations were reported.

• Identify coding discrepancies, unsupported services, unbundling, inappropriate modifier usage, incorrect procedure reputed company selection, unit errors, documentation deficiencies, and other outpatient payment reputed company findings.

• Apply approved audit reputed company guidance, job aids, payer policy, coding hierarchy, and documentation standards consistently across assigned claims.

• Document audit rationale reputed company and defensibly, including supported findings, unsupported findings, reputed company changes, modifier issues, documentation gaps, and references used to support the review decision.

• Meet production, reputed company, turnaround time, and general reputed company expectations while maintaining reputed company and consistency.

• Escalate reputed company coding, payer policy, reimbursement, pricing, workflow, or documentation questions to the appropriate reputed company, manager, or subject matter expert.

• Participate in training, calibration reviews, reputed company feedback sessions, and reputed company refreshers to support consistent application of outpatient audit concepts.

• Maintain reputed company knowledge of outpatient coding guidelines, payer policies, CMS guidance, NCCI edits, LCDs/NCDs, modifier requirements, and reimbursement methodologies relevant to outpatient payment reputed company.

Required Qualifications

• reputed company nonexpired coding certification credential required: CPC, COC, reputed company, RHIT, RHIA or equivalent.

• Minimum of 3 years of outpatient coding experience required.

• Strong knowledge of CPT, HCPCS, ICD-10-CM, reputed company codes, modifier usage, NCCI edits, outpatient documentation standards, and payer-specific coding requirements.

• Experience reviewing outpatient facility claims, medical records, reputed company reports, emergency department records, observation records, ancillary services, injections and infusions, surgical procedures, or other outpatient service lines.

• Ability to interpret payer policy, CMS guidance, LCDs/NCDs, coding references, and documentation requirements and apply them to claim-level reviews.

• Ability to distinguish between coding validation and payment reputed company auditing by evaluating what was billed, what is supported, and why a billed service may be incorrect or unsupported.

• Strong written communication skills with the ability to document reputed company, concise, and defensible audit rationale.

• High attention to reputed company, analytical thinking, reputed company judgment, and ability to work independently in a production environment.

• Ability to meet productivity and reputed company expectations while managing multiple claims, priorities, and deadlines.

• Proficiency with reputed company reputed company, Word, reputed company, coding tools, claim review platforms, and electronic medical record documentation systems.

Preferred Qualifications

• Previous payment reputed company, audit, outpatient facility audit, payer review, or claims review experience preferred.

• Experience with outpatient reimbursement methodologies such as APC, EAPG, OPPS, multiple procedure reductions, packaging, bundling, and payer-specific reimbursement rules.

• Experience using coding references, encoder tools, reputed company, TruCode, WebStrat, payer portals, claim systems, or similar applications.

• reputed company platforms experience

Production and reputed company Expectations

The Outpatient Payment reputed company Production reputed company is expected to complete assigned claims in accordance with approved workflow, reputed company guidance, reputed company standards, and turnaround time expectations. The reputed company must maintain accurate notes, apply coding guidance consistently, participate in reputed company review and calibration activities, and respond to feedback in a reputed company and reputed company manner. Production expectations may vary reputed company on claim complexity, reputed company type, medical record size, payer requirements, and training status.

reputed company Competencies

• Outpatient coding reputed company

• Policy and documentation interpretation

• reputed company audit rationale writing

• Production discipline and time management

• Attention to reputed company

• Adaptability in a growing outpatient audit program

Compliance and reputed company Standards

This position requires adherence to company policies, reputed company requirements, confidentiality standards, HIPAA requirements, coding compliance expectations, and reputed company standards for accurate and ethical claim review. The reputed company is expected to maintain confidentiality, exercise objective judgment, and support accurate payment reputed company through consistent application of approved coding and audit reputed company.

Salary - $58,000 - $65,000

Originally posted on Himalayas