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Coding Auditor
TX - Irving
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We currently have multiple openings for:Coding AuditorCoding Auditors provide medical records review of claims as requested.The successful individual will review medical record documentation, remittance advice and other documentation to determine accuracy in billing and coding; perform a clinical review of medical records and/or other documentation to determine correct coding, billing and medical necessity; complete medical review form, accurately documenting findings, and provides policy/regulatory support for determination; maintain internal quality control processes to assure the reliability of project reviews; develop and maintain documentation on quality improvement processes; provide support to internal and external customers with respect toMedicaid related issues; conducts claims research using the appropriate systems; attend on-site visits to retrieve medical records and conduct provider interviews.Requirements for this position:Certified Professional Coder (CPC, Certified Coding Specialist (CCS), Certified Fraud Examiner or other coding certification required. Bachelor’s degree in healthcare or related field preferred.Minimum of two years experience in coding, billing, as well as utilization/quality assurance review.Minimum of two years experience in related field.Advanced knowledge of NCPDP and other types of prescription drug claims is required.Working knowledge of DRGs and Medicaid coverage guidelines and payment methodologies is preferred.General writing skills and ability to produce work free from typographical or spelling errors.Shows longevity in employment with one or more past employers.Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid.Working knowledge of Microsoft Office, Internet and e-mail.Ability to travel up to 20% is required.
We currently have multiple openings for:Coding AuditorCoding Auditors provide medical records review of claims as requested.The successful individual will review medical record documentation, remittance advice and other documentation to determine accuracy in billing and coding; perform a clinical review of medical records and/or other documentation to determine correct coding, billing and medical necessity; complete medical review form, accurately documenting findings, and provides policy/regulatory support for determination; maintain internal quality control processes to assure the reliability of project reviews; develop and maintain documentation on quality improvement processes; provide support to internal and external customers with respect toMedicaid related issues; conducts claims research using the appropriate systems; attend on-site visits to retrieve medical records and conduct provider interviews.Requirements for this position:Certified Professional Coder (CPC, Certified Coding Specialist (CCS), Certified Fraud Examiner or other coding certification required. Bachelor’s degree in healthcare or related field preferred.Minimum of two years experience in coding, billing, as well as utilization/quality assurance review.Minimum of two years experience in related field.Advanced knowledge of NCPDP and other types of prescription drug claims is required.Working knowledge of DRGs and Medicaid coverage guidelines and payment methodologies is preferred.General writing skills and ability to produce work free from typographical or spelling errors.Shows longevity in employment with one or more past employers.Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid.Working knowledge of Microsoft Office, Internet and e-mail.Ability to travel up to 20% is required.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
