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Medical, Eligibility and Pharmacy claims coding including CPT, DRG, ICD10 and other industry standard classifications. The team is a mix of data managers, data scientists, reporting data analysts, SQL/MS Office/Tableau/PowerBI/Python/R programming experts, statisticians, actuaries, and custom solution architects.
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Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines.
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Working knowledge of billing/coding terminology (i.e., ICD-10, CPT, Revenue codes); Procedural knowledge of hospital and physician practice accounts receivable managementIn-depth knowledge of payor contracting and negotiationWorking knowledge of privileging, credentialing, provider enrollment and managed care contracting requirements, practices, and industry standards.
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Knowledgeable of ICD-10 and CPT codes (certified coding certification preferred) Coding certifications preferred (CPC, CRC, RHIT, RHIA) Knowledgeable of Medicaid and CMS/HHS risk adjustment programs, timelines, and governmental regulations.
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Preferred Education: Preferred Licensure: Preferred Experience: Coding (DRG/ICD/CPT/HCPCS) experience preferred. Accountable for applying skills to do the conversion of documented/written diagnoses and treatment procedures into standard codes (ICD, CPT, HCPS, etc.
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The Certified Coding Specialist must adhere to all CPT guidelines and ICD-10 Coding Guidelines. Knowledge of CPT (including Evaluation and Management), ICD-10 diagnosis and procedural. Identifies, enters and posts CPT and ICD-10 codes to the electronic health record.
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US Citizen, Green Card, H-1B, GC-EAD, H4-EAD, OPT-EAD, L2-EAD, TN Visa, E-3 Visa, CPT. Experience working with large datasets using tools like SQL, Hadoop, MapReduce, Pig/Hive, Spark/Shark. US Citizen, Green Card, H-1B, GC-EAD, H4-EAD, OPT-EAD, L2-EAD, TN Visa, E-3 Visa, CPT.
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Requires knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line. (This includes denials related to the billed CPT, diagnosis, and modifier.
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Apply working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), ICD, and CPT coding, as well as McKesson (InterQual) and/or Milliman Care Guidelines. Apply working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), ICD, and CPT coding, as well as McKesson (InterQual) and/or Milliman Care Guidelines.
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ICD-10 and CPT-4 coding experience preferred. The claims resolution specialist resolves all unpaid insurance claims by researching all incoming denials. Bethany Children’s Health Center may refuse to hire an applicant or discharge an employee in a safety-sensitive position, who tests positive for marijuana even if the applicant or employee holds a valid Oklahoma medical marijuana license.
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Profound knowledge of medical billing procedures, CPT, ICD-10 coding, and healthcare reimbursement methodologies. Stay current with healthcare industry regulations, billing guidelines, and coding standards (e.g., CPT, ICD-10, HCPCS), ensuring adherence to all legal and ethical billing practices.
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