Job Description

JOB TITLE: DRG/CPD Coder

OVERVIEW: Seeking Coders to join the DRG Review team. These coders are working with NY Medicaid to review high cost claims and may be up to multimillion dollar claims.

The target background is a medical coder with a strong DRG background. Candidates should have inpatient experience or open to someone with outpatient or a blend.

Coder will be receiving claims that have already been decided and then it is up to them to review the claim and the decision and then be able to write a summary explaining why they are upholding or overturning the decision and be able to quote the chart or the coding guidelines to substantiate. Coder will be handling anywhere from 10-12 claims a day, depending on the complexity of the claim.

DUTIES:

• Validate and verify submitted codes for DRG validation.
• Apply national coding standards and regulations to the claims and clinical data.
• Provide subject matter input and support agency-wide projects.
• Other duties as assigned.

SCHEDULE : Monday-Friday 8am-5:30pm (40 hours a week)

LOCATION: remote (can sit anywhere in the US but must be able to work EST hours)

PAY: $30-38/hr

DURATION: long term open ended contract (includes benefits, sick time, 401k, weekly pay)

QUALIFICATIONS:

• Excellent interpersonal and communication (written and verbal) skills with the ability to successfully communicate and interact with all internal and external parties.
• The ability to relate effectively with medical, technical, analytical and administrative personnel.
• The ability to work independently, as well as in a team environment.
• Proficient in the use of standard EHR applications, office technology and Microsoft applications including Word, Excel, and PowerPoint.
• Ability to handle sensitive and confidential information.
• Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS)/ Certified Coding Specialist Physician (CCS-P) required.
• Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required.
• Minimum of two (2) years of experience abstracting and coding of outpatient medical records for billing.

EDUCATION & EXPERIENCE:

• Licensed Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS)/ Certified Coding Specialist Physician (CCS-P) required.
• Bachelor’s Degree in healthcare administration or Health Information Management preferred (Associate's degree at minimum)
• Technical knowledge of coding and DRG validation with CPT, HCPCS experience and ICD-10 certification required.
• Minimum of two (2) years of experience abstracting and coding of outpatient medical records for billing.
• Experience in utilization reviews preferred.

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