Medical Coder

QualChoice Health Insurance is your trusted partner in providing the best value in health benefits for your employees or customers — or for you and your family. Our friendly, personal service and track record of treating people right are one reason we’re the quality choice for health insurance in Arkansas.

This position will assist the organization in multiple areas as it relates to correct and appropriate coding initiatives including: Claims payment, medical policy, medical studies and investigations and appeals.

* Research and resolution of coding projects as assigned such as payment studies * Document requested information from the medical record or extract data from the medical record * Determine valid encounters including legibility and valid signature requirements * Identify valid face to face encounters * Perform ongoing analysis of medical record charts for the appropriate coding compliance * Provide education to Providers and staff, as necessary to provide information and/or feedback * Identify areas of suspected fraud or abuse * Track, trend and perform investigations associated with suspect practice patterns * Assist Medical Director with studies as directed. * Collaborate with the Appeals Unit in the resolution of appeals by performing clinical edit research and review * Work with Claims on clinical edit rationale and correct coding determination * Assists the Medical Director with Payment Bundling initiatives * Review medical policies for correct code assignment * Provide ICD-10 Crosswalk support * Conducts business with high regard for corporate values and in compliance with its Code of Ethical Conduct. * Maintains high regard for member privacy and complies with information security and HIPAA policies. * Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company’s quality initiatives. * Accountable for all actions/responsibilities described in the company’s policies and procedures as they relate to this position.

* Advanced knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record. * Advanced knowledge of medical codes involving selections of most accurate and description code using the ICD-9-CM, ICD-10-CM, ICD-10-PCS, Volumes 1-3, CPT, HCPCS, DSM-IV and IHS coding conventions. * Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-9/10-CM code. * Advanced knowledge of medical codes involving selection of most accurate and descriptive code using the CPT codes for billing of third party resources. Ability to analyze trends and patterns. * Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes. * Must have good math skills and effective communication skills. Must be knowledgeable of the fiscal requirements, policies, and procedures of federal and state programs. Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data. Must have flexibility to coordinate and work between multiple computer systems. Requires skill in the use of a wide variety of office equipment including: computer, calculator, facsimile, copy machine, and other office equipment as required. Must be able to follow instructions and work independently. * High School Diploma/GED required * CPC-P/CPC-H, or equivalent * Requires 2+ years Medical coding experience * Requires proficient computer skills (MS Word, Excel, ICD-9-CM, CPT-4, Encoder) * Must have knowledge of coding guidelines, payer guidelines and federal billing guidelines. * Must have knowledge of physiology and disease processes. * High school diploma or equivalent required. * At least two years of medical coding experience required. * Proficiency in Microsoft Word and Excel required. * Current coding certification required. * Knowledge of medical coding guidelines, payer guidelines and federal billing guidelines required.