Medical Coder Job at Pyramid Consulting, Inc, Anchorage, AK

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  • Pyramid Consulting, Inc
  • Anchorage, AK

Job Description

Job Description

Immediate need for a talented Medical Coder. This is a Fulltime opportunity with long-term potential and is located in Anchorage,AK(Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-01746

Pay Range: $28 - $29/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

  • Review adjudicated medical claims that have been denied and resubmitted by providers for reconsideration.
  • Review medical documentation in support of Evaluation and Management in compliance with current CPT, HCPCS, ICD-10, and CMS guidelines, as well as company-specific reimbursement policies, competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
  • Analyze claim documentation, coding accuracy, and medical record details to determine if denial reasons are valid or if payment reconsideration is warranted.
  • Conduct detailed coding audits to validate proper code assignment and adherence to medical necessity and billing regulations.
  • Coordinates research and responds to system inquiries and appeals.
  • Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
  • Conducts research of claims systems (i.e Facets, Encoder Pro, etc) and system edits to identify adjudication issues and to audit claims adjudication for accuracy
  • Prepare clear and concise documentation outlining findings, coding corrections, and recommendations for claim outcomes.
  • Mandatory experience in payor insurance processes

Key Requirements and Technology Experience:

  • Key Skills:["Medical Coding", "Claims Review", "Denials & Appeals", "E&M Coding", "CPT", "HCPCS", "ICD-10", "CMS Guidelines", "Payor Processes", “Insurance Processes”].
  • Certified & active Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.
  • Experience with appeals and denials (NCD/LCD, Duplicate, MUE)
  • 2-3 years of prior E&M/GMC experience
  • Strong knowledge of CPT, HCPCS, ICD-10, and CMS reimbursement guidelines.
  • Minimum 3 years experience reviewing denied claims and performing coding audits in a healthcare or insurance environment.
  • Excellent analytical, communication, and documentation skills with an emphasis on attention to detail.
  • Ability to interpret medical records and apply coding principles accurately.

Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Job Tags

Full time, Contract work, Local area, Immediate start,

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