Job Position : Clinical Coder (Inpatient)

Work Type : 100% Remote

Pay range : $32 - 34 / hr

Working shift : Must be able to work any US time zone.

Duration : 6 months with possible extension

Job Summary : Under the direction of the DRG Supervisor or designee, conducts coding review of prior authorization requests for unlisted codes or services; retrospective medical claims review for coding and pricing determinations; and / or coding review for inpatient (facility) claims to include diagnosis and procedural coding with DRG assignment. Provides coding-related information to medical directors, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management, and the claims subcontractor as needed.

Key Responsibilities

Performs claims coding and pricing reviews using current coding guidelines.

Performs focused claims reviews as requested by management and summarizes findings.

Identifies and reports potential fraudulent or quality issues.

Acts as a resource for the facility staff on ICD-10-CM, ICD-10 PCS, CPT and HCPCS coding.

Researches manuals for benefits, limitations and exclusions and current coding guidelines to assist with the Referral and Authorization Decision Support tool process

Monitors and tracks timeliness of retrospective claims reviews response to ensure compliance with required timelines for completion of assigned reviews.

Identifies questionable review decisions and forwards to the Supervisor and / or Medical Director for evaluation and / or corrective action.

Provides accurate data entry in the medical management and claim processing system.

Performs other duties as assigned.

• Please note that Inpatient facility coding with DRG experience is HIGHLY preferred for this position

Essential Requirements :

Current Certification as a Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Registered Health Information Technician (RHIT)

Minimum 2 years of clinical coding experience for inpatient accounts

Minimum 2 years of claims processing experience in inpatient / outpatient accounts

Knowledge of ICD-10-CM, ICD-10-PCS, CPT and HCPCS coding

Must be able to receive a favorable interim and adjudicated final Department of Defense (DOD) background investigation.

Availability to work any shift

Ability to work independently from home (Remote)

Preferred Skills :

Experience in the private medical industry, health insurance, or Managed Care field

Experience in a fast-paced corporate environment

Familiarity with TRICARE and the military healthcare delivery system