Position Description: HMS, Coding Specialist

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Opportunity Snapshot

This role offers you the opportunity to be part of the ground floor team launching a new contract to conduct utilization review services for Massachusetts' Medicaid program. You will enjoy the "best of both worlds:" the clinical sophistication of Permedion, a recognized leader in the assessment of healthcare services, and the resources and stability of Health Management Services (HMS), our parent corporation, recently ranked #3 on Fortune's 2009 FSB 100 list of America's fastest growing small public companies.

You will review medical records to collect data, insure appropriate billing of data and follow up on questions or concerns raised by nurse and physician reviewers or health care providers. To be a good fit for this opportunity you will have an RHIA, RHIT, CCS, RN, or other relevant health care professional license and/or accreditation and a minimum of three years clinical coding experience in a hospital setting. We're looking for a professional who is able to manage multiple projects and competing priorities effectively. You also will need to be flexible and adaptable as we implement the new program.

For 35 years Permedion, an HMS company, has provided external medical peer reviews and independent health care review services for government agencies and large health care providers. Permedion is accredited by URAC in both Independent Review and Utilization Management. Founded in 1985, HMS offers one of the broadest portfolios of service to help government-sponsored healthcare plans recover billions of dollars and save billions more through cost avoidance. While others are cutting back, HMS is growing: our 2008 revenues of $184 million were up more than 20% over 2007, and that rate of growth has persisted through the first half of 2009.

What Else You'll Bring to the Table

In addition to the qualifications detailed above, you'll need:

Solid computer skills.
Outstanding organizational skills, including the ability to manage multiple priorities and multi-level tasks effectively.
Robust attention to detail.
Excellent verbal and written communication skills.
Experience with programs related to the Medicare Modernization Act or Medicaid Management Information Systems is preferred but not required.

What's in It for You

Professional development -- you'll broaden your experience with a wide variety of cases, including inpatient and outpatient hospital reviews, inpatient rehabilitation reviews, concurrent reviews and conversion reviews. In addition, you'll deepen your knowledge of Medicaid and Medicare rules.

Great work environment -- Throughout Permedion we maintain a congenial environment with a collaborative approach to achieving results. As a member of the program launch team you'll help shape the culture in the Charlestown facility.

Clinical sophistication through continuous improvement -- our URAC accreditation requires that we maintain continuous organizational improvement processes, and we never stop learning and growing. This spirit has enabled us to achieve industry recognition for our expertise. For example, we are designated by the Centers for Medicare and Medicaid Services (CMS) as one of eight Qualified Independent Contractors (QIC) in the US, meaning CMS acknowledges that we have the expertise and capabilities to perform appeals of Medicare claims between the carrier and Administrative Law Judge levels.

No signs of slowing -- Medicaid and Medicare budgets are growing (CMS predicts current Medicare/Medicaid spending levels to double by 2015) and, with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Permedion and HMS are taking advantage of this climate to drive solid growth. In addition to posting double-digit growth year over year since 2001, HMS is successfully expanding into new markets, including federal healthcare and managed care.

Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes all you would expect plus a few pleasant surprises, such as a 401(k) plan with generous employer match, flexible spending plans, and much more.

More About Your Role

If you're a good fit for this position, you already know most of what this job entails. However, to be sure we're providing a complete picture, here are some details.

On July 15, 2009 Permedion won the Massachusetts Acute Hospital Utilization Management Program contract with the University of Massachusetts, the agent administering the state's Medicaid program. In addition to the 30 professionals coming on board in facilities in Charlestown, MA, the program will take advantage of support and resources from other areas of Permedion, such as this position. The program will include three teams under the Managers of Admissions Review, Physician Relations and Retrospective Review.

You'll join the latter team of about 17, which also will include Nurse Reviewers, Project Specialists and another Coding Specialist. The initial days will involve a good deal of training, as the contract starts November 1, 2009. On an ongoing basis you will perform medical review of medical information as defined by review methodologies specific to this contract.

Keys to Success

To excel in this role you will:

Get up to speed on our technologies, systems and processes quickly.
Achieve your goals with minimal supervision, but also contribute actively as a member of the team.
Be flexible not only as we launch this new contract, but on an ongoing basis as priorities change.
Remain open to learning new technologies, processes, and skills.

If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!

Who We Are

Permedion provides external medical peer reviews and independent health care review services for government agencies and large health care providers, helping them control escalating health care costs while providing appropriate medical care. Our three primary areas of service are health care quality measurement and improvement, data analysis and management, and independent medical review.

With a unique combination of statistical and clinical expertise, Permedion works with government agencies, managed care organizations, and other payors to review, measure and improve health care quality. Our staff includes physicians, nurses, epidemiologists and data analysts, systems experts, and health administration experts. Our partners and customers include health plans, physician groups, government agencies, and professional associations.

Permedion is a wholly owned subsidiary of Health Management Systems, Inc. (HMS), providing clinical expertise to all HMS service lines. HMS is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more.

We are an equal opportunity employer. EOE M/F/D/V

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