Position Summary:

The Clinical Data Coder/Specialist - Pre Claims is responsible for the accurate and timely work to effect filing of Insurance claims.  Qualified individual will demonstrate clinical claims detailed knowledge, coding and delivering resolutions to missing/ incomplete order data. This person will identify invalid clinical values to help drive clean claims and revenue pull through on all products and services. 

This position will support the Revenue Cycle function and report to the Front End Manager of Revenue Cycle.

Essential Duties and Responsibilities:

- Identify order and reimbursement deficiencies - both clinical and code related 

- Investigate and correct, where appropriate, deficient clinical claim information 

-Identify and escalate missing, and sometimes invalid, clinical order data for timely contact   resolution with supporting cross functional teams

- Partner with multiple internal cross-functional teams and successfully manage multiple product projects simultaneously. 

-Research claim and account information using various systems and portals internal and external

-Stay current with relevant medical billing regulations, rules and guidelines

-Complete position responsibilities within the appropriate time frame while adhering to quality standards

-Ability to interact with various insurances/ third party payors accurately and timely to ensure that authorizations are obtained and necessary documents are available for claim support based on internal and external policies and regulations

- Participate in clinical data management activities including leading clinical data initiatives, analysis and optimization of our clinical data capture workflows

- Translate data into meaningful information and knowledge that supports decision making or determining action that drives performance improvement and quality

- Identifies and uses internal and external sources of information for benchmarking and comparative performance, which includes networking with clinical communities, researching literature and agencies, and staying current on new indicators and other requirements

-Act as SME for multiple purposes where coding and clinical operations data is relevant- Support and comply with the company’s policies and procedures. 

-Maintains strictest confidentiality, and adheres to all HIPAA guidelines/regulations- Regular and reliable attendance. - Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.

-Perform analytical and special projects, prepare ad hoc reports/data queries as may be assigned/requested, working with leadership

Qualifications:

Minimum Qualifications:

- Bachelor degree in relevant field is preferred- 3+ years professional coding experience with current certification including International Classification of Diseases (ICD-10) and Coding Procedure Terminology (CPT) and HCPCS coding. - Authorization to work in the United States without sponsorship. 

- Certified coder designation/ certification by NHA, AHIMA or  AAPC

- Superior organization skills, detail oriented, and ability to be persistent and follow through

- Problem-solving, ability to adapt, flexibility in approaches to accomplishing tasks, and ability to independently arrive at creative solutions to problems

- Excellent communication skills, both verbal and written, particularly the ability to convey technical information in an accessible and understandable manner

- Ability to work both independently and in collaboration with individuals from various disciplines

Preferred Qualifications:

- 5+ years of experience coding in the medical/healthcare billing area- Lab a plus
- Any years of experience in the revenue cycle function to include third party payer experience.
- Thorough understanding of professional coding, documentation, medical billing processes.
- Deep familiarity with payer/insurance Medical policy, Prior Auth, claims, appeals and reimbursement processes.
- Knowledge and familiarization with Medicare billing regulations and reimbursement methodologies for Laboratory

Pay Range: The pay range for this role is $30.00-$38.00. Actual compensation packages are based on a wide array of factors unique to each candidate, including but not limited to skill set, years & depth of experience, certifications and specific office location. This may differ in other locations due to cost of labor considerations.

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