Coding Quality Analyst

1. About Our Client:

The organization operates in the healthcare sector, focusing on leveraging technology to improve health outcomes for millions by connecting individuals with care, pharmacy benefits, data, and resources. It addresses challenges related to healthcare access and optimization on a large scale.

2. About the Opportunity:

The Coding Quality Analyst is responsible for reviewing medical records to identify potentially fraudulent or suspicious activities. This role ensures the accuracy and integrity of medical coding to support proper billing and compliance. It contributes to the organization by mitigating risks related to fraud and enhancing the quality of healthcare data.

3. Responsibilities:

• Review records flagged as suspicious or potentially fraudulent using current coding guidelines including CPT, ICD-9/10, and HCPCS
• Document review decisions clearly in company systems
• Communicate findings and decisions to internal and external stakeholders
• Collaborate with team members to identify trends and issues related to billing and coding

4. Requirements:

• High School Diploma or GED
• Active and unrestricted coding certification from AHIMA (CCS, CCS-P, or RHIT) or AAPC (CPC)
• Minimum 2 years of CPT medical coding experience
• Minimum 2 years of medical record auditing experience
• Ability to work full-time schedules Monday through Friday with flexibility for any shift between 8am and 5pm CST and occasional overtime
• Must be at least 18 years old

Preferred:

• Experience in Behavioral Health
• Knowledge of fraud, waste, abuse, and error
• Familiarity with CMS 1500 and UB04 data elements
• Experience with Encoder Pro software

Telecommuting Requirements:

• Maintain security of sensitive company documents
• Have a dedicated, private work area
• Access to approved high-speed internet

Soft Skills:

• Strong oral and written communication
• Effective organizational and time management skills
• Ability to meet productivity standards while handling multiple priorities

5. Pay Range and Compensation Package:

• The hourly pay for this role ranges from $24 to $43 based on full-time employment

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.