Inpatient Medical Billing and Coding Analyst and Cost Reviewer

Inpatient Medical Billing and Coding Analyst and Cost Reviewer [PR0001B]

- Full-time

ProSidian is looking for “Great People Who Lead” at all levels in the organization. Are you a talented professional ready to deliver real value to clients in a fast-paced, challenging environment? ProSidian Consulting is looking for professionals who share our commitment to integrity, quality, and value.

ProSidian is a management and operations consulting firm with a reputation for its strong national practice spanning six solution areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations.

ProSidian Seeks a Inpatient Medical Billing & Coding Analyst & Cost Reviewer (Full-Time) in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command whose mission is to provide a proactive and patient-centered system of health with the focus on the medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force.

The ProSidian Engagement Team Members work to provide health coding services to a branch of the United States Armed Forces' Regional Health Command- Atlantic (RHC-A) military treatment facilities and provide services to MTFs located in the National Capital Region and the following RHC-A Medical Treatment Facility (MTFs) locations: AL | PR | FL | GA | KY | DC | MD | PA | VA | NY | NC | SC. The ProSidian Contract Service Providers (CSP) will work in conjunction with other health care providers, professionals, and non-contract personnel.

MD - Medical Billing & Coding Candidates shall work to support requirements as a Inpatient Medical Billing & Coding Analyst & Cost Reviewer and review inpatient health records and/or Electronic Medical Record (EMR) for appropriate evaluation and management services. This position will validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records. Will employ critical analysis and coding skills to review inpatient records for quality and comprehensive coding.

- Prepares and maintains a variety of statistical reports and records while ensuring strict confidentiality of financial and medical records.
- Responsible for resolving questions, inconsistencies, or missing information.
- Conducts high level of bill review.
- Resolves daily coding scrubber errors to ensure accurate coding structure for correct billing.
- Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required for the resolution of coding denials.
- Advises and instructs providers regarding billing and documentation policies, procedures, and regulations.
- Interacts with provider staff regarding conflicting, ambiguous or non-specific medical documentation, obtaining clarification of same; and educates providers regarding changes and measuring compliance.
- Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews; prepares periodic reports for the HCC findings, trends and clinical staff identifying corrective measures necessary to resolve denial problems.
- Compiles and reports HCC statistical data.

The Inpatient Medical Billing & Coding Analyst & Cost Reviewer shall have consecutive employment in a position with comparable responsibilities within the past five (5) years. Must be able to use a computer to communicate via email; and proficient in Microsoft Office Products (Word/Excel/PowerPoint) and related tools and technology required for the position.

- 2 years of experience in medical coding and billing training, risk adjustment coding or Hierarchical Condition Category (HCC) coding required; or equivalent combination of education and experience; (Medical terminology, anatomy & physiology required).
- Registered Health Information Technician (RHIT) Certified Coding Specialist – Professional (CCS-P) or Certified Coding Specialist (CCS) required. Certified coder through AHIMA or AAPC preferred but not required.
- Experience with various risk adjustment methodology and chart audits.
- Strong knowledge of CPT procedure codes and diagnostic ICD-10-CM codes and/or MS-DRG classification codes, and application of modifiers.
- Ability to use computer software. Excellent communication, basic math, and reasoning skills.
- Knowledge of medical terminology, anatomy, physiology, and pathophysiology is preferred.
- Outstanding oral and written communications skills.
- Clinical background and previous chart abstraction experience is also preferred.

TRAVEL: Travel as coordinated with the technical point of contact and approved in writing by the Contracting Officer in advance, is allowed, in accordance with Federal Travel Regulations.

LOCATION: Work shall be conducted CONUS - Fort Stewart, GA.

As a condition of employment, all employees are required to fulfill all requirements of the roles for which they are employed; establish, manage, pursue, and fulfill annual goals and objectives with at least three (3) Goals for each of the firm's Eight ProSidian Global Competencies.

CORE COMPETENCIES

- Teamwork – ability to foster teamwork collaboratively as a participant, and effectively as a team leader.
- Leadership – ability to guide and lead colleagues on projects and initiatives.
- Business Acumen – understanding and insight into how organizations perform, including business processes, data, systems, and people.
- Communication – ability to effectively communicate to stakeholders of all levels orally and in writing.
- Motivation – persistent in pursuit of quality and optimal client and company solutions.
- Agility – ability to quickly understand and transition between different projects, concepts, initiatives, or work streams.
- Judgment – exercises prudence and insight in decision-making process while mindful of other stakeholders and long-term ramifications.
- Organization – ability to manage projects and activity, and prioritize tasks.

ADDITIONAL INFORMATION - See Below Instructions On The Best Way To Apply

ProSidian Consulting is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, or Vietnam era, or other eligible veteran status, or any other protected factor. All your information will be kept confidential according to EEO guidelines.

ProSidian Consulting has made a pledge to the Hiring Our Heroes Program of the U.S. Chamber of Commerce Foundation and the “I Hire Military” Initiative of The North Carolina Military Business Center (NCMBC) for the State of North Carolina. All applicants are encouraged to apply regardless of Veteran Status.

Furthermore, we believe in "HONOR ABOVE ALL" - be successful while doing things the right way. The pride comes out of the challenge; the reward is excellence in the work.

FOR EASY APPLICATION USE OUR CAREER SITE LOCATED ON http://www.ProSidian.com/ OR SEND YOUR RESUME’S, BIOS, AND SALARY EXPECTATION / RATES TO CAREERS @ PROSIDIAN.COM.

ONLY CANDIDATES WITH REQUIRED CRITERIA ARE CONSIDERED.

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