Employment Type : Full-Time
JOB TITLE: CLINICAL (CODING) REVIEWER Cloudmed is a first-of-its-kind, single-source enterprise platform provider of Revenue Intelligence™ solutions for hospitals. Cloudmed’s approach of combining human expertise with advanced technology utilizing machine learning algorithms provides a smarter, more predictive way for clients to realize all potential revenue. Today, Cloudmed partners with over 3,100 healthcare providers in the United States and recovers over $1.2 billion of underpaid or unidentified revenue for clients annually. Cloudmed (Triage solution) is the 2020 Revenue Integrity and Underpayment Services KLAS® Category Leader and its solution suites have HFMA Peer Review status and are HITRUST certified. The Clinical (Coding) Reviewer is responsible for the review and interpretation of medical records to draft appeals of denied and underpaid claims. The Clinical (Coding) Reviewer reviews medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Responsibilities include drafting appeal letters based on clinical judgment and knowledge and making coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic. Review and interpret medical records to appeal denied and underpaid claims. Apply clinical judgment and knowledge for DRG downgrades performed as a result of a Clinical Validation Review by an insurer or third-party auditor. Draft appeal letters that are well written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance, and Coding Clinic. Handle rush and high balance cases in accordance with office policy for prioritization. Ensure that all appeals are completed timely and sent by the specified deadline. Licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) Active CPC or CCS certification; or, in lieu of active coding certification, a minimum of 2 years of experience in a Clinical Documentation Improvement (CDI) position Direct experience in medical record reviews/audits Knowledge of medical coding for inpatient and outpatient claims (CPT, ICD-9/10, HCPCS) and reimbursement guidelines (MS & APR DRG, APC) Knowledge of HIPAA laws and requirements required Strong analytical skills and strong proficiency in Microsoft Office Tools Excellent interpersonal, written and oral communication skills Coding training and education experience preferred Prior medical coding/billing experience General understanding of hospital collections in a variety of patient care settings The culture at Cloudmed embraces those that demonstrate a deep passion for solving the problems of healthcare with enthusiasm for building positive working relationships and winning as a team. Take the work seriously, but don’t take yourself too seriously. Creating a strong workplace culture has been one of our staples, which we believe encourages and inspires employees to do their best. Join a fulfilling team of like-minded individuals who can get their work done, but still have fun! Cloudmed provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.
COMPANY OVERVIEW
DESCRIPTION
RESPONSIBILITIES
Familiarity with and ability to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters.
REQUIRED QUALIFICATIONS
DESIRED QUALIFICATIONS
CULTURE FIT
BENEFITS
Cloudmed is an Equal Opportunity Employer