Outpatient Medical Billing and Coding Analyst and Cost Reviewer

Outpatient Medical Billing and Coding Analyst and Cost Reviewer

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 Outpatient Medical Billing and Coding Analyst and 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 who's mission is to provide a proactive and patient-centered system of health with the focus on athe medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force. The Armed Forces' overall mission is "to fight and win our Nation's wars, by providing prompt, sustained, land dominance, across the full range of military operations and the spectrum of conflict, in support of combatant commanders". The Regional Health Command's Readiness Mission includes dental care of active duty Soldiers, public health services, veterinary services, and providing management and support to wounded, ill and injured Soldiers assigned to its seven warrior transition units.

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. Additionally, the vendor may be required to provide coding services to other military services (i.e. U.S. Navy, U.S. Air Force). 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 Outpatient Medical Billing and Coding Analyst and Cost Reviewer and review outpatient 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 outpatient 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 insure 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 Outpatient Medical Billing and Coding Analyst and 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/Power point) and related tools and technology required for the position.

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems, etc. No healthcare facility can function effectively without medical billers, making certified professionals crucial in the healthcare industry.

Must Have A Minimum Of 2 Yrs Certification Of One Of The Following: a) American Health Information Management Association (AHIMA) Credentials: RHIA - Risk Health Information Administration | RHIT - Registered Health Information Technician | CCA - Certified Coding Associate | CCS- Certified Coding Specialist and/or b) American Academy of Professional Coders (AAPC): CPC - Certified Professional Coder | COC - Certified Outpatient Coder | CIC - Certified Inpatient Coder | CRC - Certified Risk Coder

• HS Diploma or associate degree
• 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.

Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined. Keys Skillset Attributes Required To be successful are Attention to Detail | Discretion | Computer Skills | Office Skills | Organizational Skills | Writing Skills | Operations | Coding | Quality | Compliance | Analytical abilities - to understand and analyze patients' health records, Strong morals, Social skills, Tech savvy.

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

• Excellent oral and written communication skills
• Attention to detail
• Analytical and evaluation skills
• Proficient with Microsoft Office Products (Microsoft Word, Excel, PowerPoint, Publisher, & Adobe)
• U.S. Citizenship Required

Additional Information

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 firms Eight Prosidian Global Competencies [1 - Personal Effectiveness | 2 - Continuous Learning | 3 - Leadership | 4 - Client Service | 5 - Business Management | 6 - Business Development | 7 - Technical Expertise | 8 - Innovation & Knowledge Sharing (Thought Leadership)]; and to support all business development and other efforts on behalf of ProSidian Consulting.

• 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

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• Business Tools – understanding and proficiency with business tools and technology, including Microsoft Office. The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
• Commitment - to work with smart, interesting people