Job Description:

• Audit Claims: Review inpatient (IP) and outpatient (OP) claims for completeness, accuracy, and compliance with clinical documentation.
• Coding Validation: Validate ICD-10, CPT, HCPCS codes, and modifier usage to ensure correct coding.
• Denial Management: Identify, analyze, and resolve claim denials, rejections, and discrepancies to optimize revenue.
• Regulatory Adherence: Ensure compliance with DHA guidelines, payer protocols, and Medicare regulations.
• Documentation Improvement: Collaborate with billing teams and clinicians to improve documentation quality.
• Reporting: Generate audit reports, track trends, and identify systemic issues for process improvement. 

• Credentials: Active coding certification required, such as Certified Professional Coder (CPC), Certified Coding Specialist (CCS), RHIT, or RHIA.
• Experience: Proven experience in medical coding, claims auditing, or Revenue Cycle Management (RCM).
• Technical Knowledge: In-depth understanding of hospital billing systems, ICD-10-CM/CPT coding, and payment methodologies.
• Analytical Skills: Strong analytical ability to identify patterns, errors, and fraudulent activity.

Industry:

HealthCare

Category:

Health

Skills: