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Assigns ICD-10, CPT, and HCPCS codes based on provider documentation. Reviews, works, and corrects both internal errors and denials from insurance companies and re-files the claim.
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Maintain continuing education treatment trends, current medical terminology used in pre-certification, and ICD-10, CPT and HCPCS codes. Correspond with medicare and various insurance companies to facilitate obtaining pertinent data on compliance, authorizations, verifications, progress notes, medical necessity guidelines and precertification and pre-authorization requirements.
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Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD-10 diagnoses and HCC disease categories.
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Performs HCC coding on projects for MA, ACA, or End Stage Renal Disease (ESRD) through the assignment of appropriate ICD-10 diagnosis codes under the direction of management; may flex between coding projects with different MA, ESRD, or ACA HCC Models.
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Working knowledge of ICD-9-10 medical coding and billing and medical terminology. Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures.
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Associates degree in medical billing/coding, health insurance, healthcare, or related field. 3 years of medical billing/coding, health insurance, and/or healthcare experience.
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Familiarity with insurance coding systems (e.g., CPT, ICD-10) and insurance claim processes. Prior experience in orthopaedic preauthorization or medical insurance verification preferred.
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This job will deliver value to the Health Plan and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and/or Affordable Care Act (ACA) using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, and Centers for Medicare and Medicaid Services (CMS) coding guidelines.
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4+ years of medical billing/coding, medical/pharmaceuticals sales, hospital revenue cycle, orhealthcare insurance/payer experience. billing competencies including CPT, ICD-10, HCPCS coding and EOB interpretation.
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Business Office Medical Coding Specialist-Full Time. Responsible for correctly coding healthcare claims in order to obtain reimbursement from insurance companies and government healthcare programs.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
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Medical Coding or Billing. Lifting: up to 10 pounds. Lifting: 10 to 25 pounds. 1 year of HCC risk adjustment coding. Associate Hierarchical Condition Category (HCC) Coding Specialist.
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Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making. Works closely with team members, and leadership to identify and deliver high quality and accurate risk adjustment coding.
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1+ years of experience in a medical billing office, medical office setting, or insurance company to include processing claims and a working knowledge of CPT, ICD-10, and HCPC coding.
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As a Billing Specialist for our surgery centers, you will be responsible for providing and contributing to the company’s mission, vision, and values by accurately billing all diagnosis and procedures from medical records with proper ICD-10 and CPT-4 codes.
$15.86 - $22.21 an hourFull-timeExpandApply NowActive JobUpdated Today
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