Remote Medical Coding Specialist

Location: Montgomery, AL

Please note: We are not hiring candidates from CA, DC, MN, CO, HI, NJ, CT, IL, NV, DE, MA, or NY.

Job Summary: As a Clinical Coding Analyst, your main responsibility is to conduct inpatient chart reviews before billing, focusing on MS DRG assignment. You will be responsible for identifying revenue opportunities and ensuring compliance based on the Official ICD-10-CM/PCS Guidelines for Coding and Reporting, AHA Coding Clinics, disease processes, procedure recognition, and clinical knowledge.

You’ll be a great fit for this role if you have:

• AHIMA credential of CCS, CDIP, or ACDIS credential of CCDS (required)
• Graduate of an accredited Health Information Technology or Administration program with AHIMA credential of RHIT or RHIA preferred
• Minimum of 7 years of experience in acute inpatient hospital coding, auditing, and/or CDI in a large tertiary hospital (required)
• Experience with CDI (Clinical Documentation Improvement) programs preferred
• Extensive knowledge of ICD-10 CM/PCS (required)
• Experience with electronic health records (i.e., Cerner, Meditech, Epic, etc.) required
• Experience working remotely required
• Excellent oral and written communication skills required
• Analytical ability, initiative, and resourcefulness
• Ability to work independently
• Excellent planning and organizational skills
• Teamwork and flexibility
• Proficiency in Microsoft Office Word and Excel programs

Essential Job Duties and Responsibilities:

• Conduct daily pre-bill chart reviews and communicate findings to clients within 24 hours
• Provide daily client volumes to Audit Manager before 7am EST
• Review electronic health records to identify revenue opportunities and coding compliance issues
• Discuss potential MS DRG recommendations and physician query opportunities with the Company Physician(s) before submitting recommendations to clients
• Upload daily work list into the MS DRG Database for assigned clients and enter required data elements
• Compose recommendations (e.g., increased reimbursement, decreased reimbursement) and communicate them to clients within 24 hours
• Handle client questions and rebuttals on reviewed cases within 24 hours
• Review and appeal Medicare and/or third-party denials if necessary
• Review 30 Day Readmissions and Mortality quality measures for specific cohorts of traditional Medicare payers
• Maintain IT access at assigned client sites
• Stay updated on ICD-10-CM/PCS code changes, AHA Coding Clinic, and Medicare regulations
• Utilize internal resources such as TruCode, I10 Wiki, and CDocT
• Adhere to all company policies and procedures

Schedule: You have the freedom to choose your work hours. However, all Clinical Coding Analysts are required to report daily client volumes to the Audit Manager by 7am EST. Our typical company hours are 8am-5pm EST/CST. It is recommended that you schedule daily meetings with the Physician team between 7:30am-6pm EST to align with their availability.

Home Office Requirements:

• High-speed internet connection
• Dedicated secure workspace to ensure HIPAA Privacy and Security compliance when viewing protected health information (PHI)
• The Company will provide a laptop and access to necessary resources for the job

Interview Process:

• Case Study Skills Assessment (PCS Coding and Clinical Validation)
• Audit Manager/Team Lead Meeting (Video Call, 1 hour)
• Verbal Case Study Discussion (Video Call, 1 hour)