Outpatient Medical Billing and Coding Analyst and Cost Reviewer

Job Description

ProSidian Seeks a Outpatient Medical Billing and Coding Analyst and Cost Reviewer (Full-Time) in CONUS - Fort Stewart, GA to support an engagement for a branch of the United States Armed Forces' Regional Health Command who's mission is to provide a proactive and patient-centered system of health with the focus on athe medical readiness of all Soldiers and for those entrusted to the care for a medically-ready force.  The Armed Forces' overall mission is "to fight and win our Nation's wars, by providing prompt, sustained, land dominance, across the full range of military operations and the spectrum of conflict, in support of combatant commanders".  The Regional Health Command's Readiness Mission includes dental care of active duty Soldiers, public health services, veterinary services, and providing management and support to wounded, ill and injured Soldiers assigned to its seven warrior transition units. 

The ProSidian Engagement Team Members work to provide health coding services to a branch of the United States Armed Forces' Regional Health Command- Atlantic (RHC-A) military treatment facilities and provide services to MTFs located in the National Capital Region and the following RHC-A Medical Treatment Facility (MTFs) locations: AL | PR | FL | GA | KY | DC | MD | PA | VA | NY | NC | SC.  Additionally, the vendor may be required to provide coding services to other military services (i.e. U.S. Navy, U.S. Air Force).  The ProSidian Contract Service Providers (CSP) will work in conjunction with other health care providers, professionals, and non-contract personnel.

MD - Medical Billing & Coding Candidates shall work to support requirements as a Outpatient Medical Billing and Coding Analyst and Cost Reviewer and review outpatient health records and/or Electronic Medical Record (EMR) for appropriate evaluation and management services. This position will validate provider, vendor, and internal diagnosis coding for accuracy by reviewing and analyzing samples of coding and claims extract compared to actual medical records. Will employ critical analysis and coding skills to review outpatient records for quality and comprehensive coding.

• Prepares and maintains a variety of statistical reports and records while ensuring strict confidentiality of financial and medical records.
• Responsible for resolving questions, inconsistencies, or missing information
• Conducts high level of bill review
• Resolves daily coding scrubber errors to insure accurate coding structure for correct billing.
• Resolves claim denials related to coding errors; performs coding charge corrections and rebilling as required for the resolution of coding denials.
• Advises and instructs providers regarding billing and documentation policies, procedures, and regulations.
• Interacts with provider staff regarding conflicting, ambiguous or non-specific medical documentation, obtaining clarification of same; and educates providers regarding changes and measuring compliance.
• Develops preventive measures in response to patterns identified through analysis of claims denial data and HCC reviews; prepares periodic reports for the HCC findings, trends and clinical staff identifying corrective measures necessary to resolve denial problems.
• Compiles and reports HCC statistical data

Qualifications

The Outpatient Medical Billing and Coding Analyst and Cost Reviewer shall have consecutive employment in a position with comparable responsibilities within the past five (5) years, Must be able to use a computer to communicate via email; and proficient in Microsoft Office Products (Word/Excel/Power point) and related tools and technology required for the position. 

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems, etc.  No healthcare facility can function effectively without medical billers, making certified professionals crucial in the healthcare industry. 

Must Have A Minimum Of 2 Yrs Certification Of One Of The Following: a) American Health Information Management Association (AHIMA) Credentials:  RHIA - Risk Health Information Administration | RHIT - Registered Health Information Technician | CCA - Certified Coding Associate | CCS- Certified Coding Specialist and/or b) American Academy of Professional Coders (AAPC): CPC - Certified Professional Coder | COC - Certified Outpatient Coder | CIC -   Certified Inpatient Coder | CRC - Certified Risk Coder

Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined.  Keys Skillset Attributes Required To be successful are Attention to Detail | Discretion | Computer Skills | Office Skills | Organizational Skills | Writing Skills | Operations | Coding | Quality | Compliance | Analytical abilities - to understand and analyze patients' health records, Strong morals, Social skills, Tech savvy.

• HS Diploma or associate degree
• 2 years of experience in medical coding and billing training, risk adjustment coding or Hierarchical Condition Category (HCC) coding required; or equivalent combination of education and experience; (Medical terminology, anatomy & physiology required)
• Registered Health Information Technician (RHIT) Certified Coding Specialist – Professional (CCS-P) or Certified Coding Specialist (CCS) required. Certified coder through AHIMA or AAPC preferred but not required.
• Experience with various risk adjustment methodology and chart audits.
• Strong knowledge of CPT procedure codes and diagnostic ICD-10-CM codes and/or MS-DRG classification codes, and application of modifiers
• Ability to use computer software. Excellent communication, basic math, and reasoning skills.
• Knowledge of medical terminology, anatomy, physiology, and pathophysiology is preferred.
• Outstanding oral and written communications skills
• Clinical background and previous chart abstraction experience is also preferred.

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems, etc.  No healthcare facility can function effectively without medical billers, making certified professionals crucial in the healthcare industry. 

Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined.  Keys Skillset Attributes Required To be successful are Attention to Detail | Discretion | Computer Skills | Office Skills | Organizational Skills | Writing Skills | Operations | Coding | Quality | Compliance | Analytical abilities - to understand and analyze patients' health records, Strong morals, Social skills, Tech savvy.

TRAVEL:  Travel as coordinated with the technical point of contact and approved in writing by the Contracting Officer in advance, is allowed, in accordance with Federal Travel Regulations.  

LOCATION:  Work shall be conducted CONUS - Fort Stewart, GA

• Excellent oral and written communication skills
• Attention to detail
• Analytical and evaluation skills
• Proficient with Microsoft Office Products (Microsoft Word, Excel, PowerPoint, Publisher, & Adobe)
• U.S.  Citizenship Required

Additional Information

As a condition of employment, all employees are required to fulfill all requirements of the roles for which they are employed; establish, manage, pursue, and fulfill annual goals and objectives with at least three (3) Goals for each of the firms Eight Prosidian Global Competencies [1 - Personal Effectiveness | 2 - Continuous Learning | 3 - Leadership | 4 - Client Service | 5 - Business Management | 6 - Business Development | 7 - Technical Expertise | 8 - Innovation & Knowledge Sharing (Thought Leadership)]; and to support all business development and other efforts on behalf of ProSidian Consulting.  

CORE COMPETENCIES

• Teamwork – ability to foster teamwork collaboratively as a participant, and effectively as a team leader
• Leadership – ability to guide and lead colleagues on projects and initiatives
• Business Acumen – understanding and insight into how organizations perform, including business processes, data, systems, and people
• Communication – ability to effectively communicate to stakeholders of all levels orally and in writing
• Motivation – persistent in pursuit of quality and optimal client and company solutions
• Agility – ability to quickly understand and transition between different projects, concepts, initiatives, or work streams
• Judgment – exercises prudence and insight in decision-making process while mindful of other stakeholders and long-term ramifications
• Organization – ability to manage projects and activity, and prioritize tasks

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OTHER REQUIREMENTS

• Business Tools –  understanding and proficiency with business tools and technology, including Microsoft Office. The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
• Business Tools – understanding and proficiency with business tools and technology, including Microsoft Office. The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
• Commitment - to work with smart, interesting people with diverse backgrounds to solve the biggest challenges across private, public and social sectors
• Curiosity – the ideal candidate exhibits an inquisitive nature and the ability to question the status quo among a community of people they enjoy and teams that work well together
• Humility – exhibits grace in success and failure while doing meaningful work where skills have impact and make a difference
• Willingness - to constantly learn, share, and grow and to view the world as their classroom

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BENEFITS AND HIGHLIGHTS

ProSidian Employee Benefits and Highlights: Your good health and well-being are important to ProSidian Consulting. At ProSidian, we invest in our employees to help them stay healthy and achieve work-life balance. That’s why we are also pleased to offer the Employee Benefits Program, designed to promote your health and personal welfare. Our growing list of benefits currently include the following for Full Time Employees:

• Competitive Compensation: Pay range begins in the competitive ranges with Group Health Benefits, Pre-tax Employee Benefits, and Performance Incentives. For medical and dental benefits, the Company contributes a fixed dollar amount each month towards the plan you elect. Contributions are deducted on a Pre-tax basis.
• Group Medical Health Insurance Benefits: ProSidian partners with BC/BS, to offer a range of medical plans, including high-deductible health plans or PPOs. ||| Group Dental Health Insurance Benefits: ProSidian dental carriers - Delta, Aetna, Guardian, and MetLife.
• Group Vision Health Insurance Benefits:ProSidian offers high/low vision plans through 2 carriers: Aetna and VSP.
• 401(k) Retirement Savings Plan: 401(k) Retirement Savings Plans help you save for your retirement for eligible employees. A range of investment options are available with a personal financial planner to assist you. The Plan is a pre-tax Safe Harbor 401(k) Retirement Savings Plan with a company match.
• Vacation and Paid Time-Off (PTO) Benefits: Eligible employees use PTO for vacation, a doctor’s appointment, or any number of events in your life. Currently these benefits include Vacation/Sick days – 2 weeks/3 days | Holidays - 10 ProSidian and Government Days are given.
• Pre-Tax Payment Programs: Pre-Tax Payment Programs currently exist in the form of a Premium Only Plan (POP). These Plans offer a full Flexible Spending Account (FSA) Plan and a tax benefit for eligible employees.
• Purchasing Discounts & Savings Plans: We want you to achieve financial success. We offer a Purchasing Discounts & Savings Plan through The Corporate Perks Benefit Program. This provides special discounts for eligible employees on products and services you buy on a daily basis.
• Security Clearance: Due to the nature of our consulting engagements there are Security Clearance requirements for Engagement Teams handling sensitive Engagements in the Federal Marketplace. A Security Clearance is a valued asset in your professional portfolio and adds to your credentials.
• ProSidian Employee & Contractor Referral Bonus Program: ProSidian Consulting will pay up to 5k for all referrals employed for 90 days for candidates submitted through our Referral Program.
• Performance Incentives: Due to the nature of our consulting engagements there are performance incentives associated with each new client that each employee works to pursue and support.
• Flexible Spending Account: FSAs  help you pay for eligible out-of-pocket health care and dependent day care expenses on a pre-tax basis. You determine your projected expenses for the Plan Year and then elect to set aside a portion of each paycheck into your FSA.
• Supplemental Life/Accidental Death and Dismemberment Insurance: If you want extra protection for yourself and your eligible dependents, you have the option to elect supplemental life insurance. D&D covers death or dismemberment from an accident only.
• Short- and Long-Term Disability Insurance: Disability insurance plans are designed to provide income protection while you recover from a disability.

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ADDITIONAL INFORMATION - See Below Instructions On The Best Way To Apply

ProSidian Consulting is an equal opportunity employer and considers qualified applicants foremployment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, or Vietnam era, or other eligible veteran status, or any other protected factor. All your information will be kept confidential according to EEO guidelines.

ProSidian Consulting has made a pledge to the Hiring Our Heroes Program of the U.S. Chamber of Commerce Foundation and the “I Hire Military” Initiative of The North Carolina Military Business Center (NCMBC) for the State of North Carolina. All applicants are encouraged to apply regardless of Veteran Status.

Furthermore, we believe in "HONOR ABOVE ALL"  - be successful while doing things the right way. The pride comes out of the challenge; the reward is excellence in the work.

FOR EASY APPLICATION USE OUR CAREER SITE LOCATED ON http://www.ProSidian.com/ OR SEND YOUR RESUME’S, BIOS, AND SALARY EXPECTATION / RATES TO CAREERS @ PROSIDIAN.COM.

ONLY CANDIDATES WITH REQUIRED CRITERIA ARE CONSIDERED.

Be sure to place the job reference code in the subject line of your email.  Be sure to include your name, address, telephone number, total compensation package, employment history, and educational credentials.