Job Description Summary

The 1st Party Code Reviewer is responsible for reviewing medical codes to determine that appropriate coding is applied, proper supporting documentation submitted and duplicate identification.

Job Duties

• Make coding and payment determinations based on fee schedule, CPT, AMA, Medicare guidelines and standard of practice guidelines.
• Problem-solving skills and independent decision-making skills.
• Communication with Clients, Attorney’s, and Providers to solve denial issues.
• Provide summaries regarding coding decisions.
• Attend arbitration hearings, if needed.
• Reviews appeals for reconsideration of payment.
• Other duties as assigned.

Typical schedule for this role will be: Monday thru Friday - 8 a.m. – 4:30 p.m. (central standard time) with the ability and flexibility to work weekends (specifically Saturdays).

Ability to work in a home environment (requires broadband internet access such as cable or Verizon FIOS – DSL and Satellite are not acceptable) is required. Minimum download speed of 15mbps and a minimum upload speed of 5mbps is required.

Qualifications

• 3 years’ prior coding experience is required
• Professional coding certification through AAPC (CPC) or AHIMA (CCS, CCA) is required
• Knowledge of ICD9, CPT, HCPCs, and CDT codes
• Knowledge of medical terminology and anatomy
• Computer literate
• Excellent organizational skills
• Excellent verbal and written communication skills
• Ability to work in a fast-paced environment
• Detail oriented
• Team player
• Ability to work weekends