Medical Code Review Processor
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.
- 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.
- 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