Medical Billing and Coding Analyst
Medical Billing and Coding Analyst
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Key Responsibilities:
- Forensic Review:
- Conduct comprehensive forensic examinations of medical records bills and associated documents to identify inaccuracies misrepresentations or instances of fraud.
- Evaluate and interpret CPT ICD HCPCS and other relevant coding systems to pinpoint discrepancies or inaccuracies.
- Understand and navigate EHR systems and billing software. Assist with internal or external audits regarding billing and documentation.
- Legal Testimony:
- Serve as an expert witness in legal proceedings providing clear accurate and authoritative testimony on medical coding billing Medicare allowances UCR (Usual Customary and Reasonable) rates EHR platforms and healthcare compliance matters.
- Prepare comprehensive reports and documentation to support legal findings.
- Documentation & Reporting:
- Document findings clearly and concisely generating reports detailing discrepancies overcharges or suspected fraud.
- Collaborate with legal and compliance teams providing them with detailed evidence and databacked insight for potential legal proceedings.
- Compliance & Best Practices:
- Stay updated on the latest medical coding and billing regulations ensuring all analyses align with current standards and best practices.
- Advise medical and administrative teams on compliance requirements and potential areas of risk.
- Collaboration & Consultation:
- Work closely with healthcare providers insurance companies and legal entities to provide expertise on medical billing and coding matters UCR rates proper documentation and methodology.
- Serve as a consultant to payer sources and attorneys offering guidance on best practices and potential areas of improvement.
- Continued Education:
- Attend workshops conferences and training sessions to stay current on the latest trends and developments in the forensic medical billing and coding field.
- Maintain relevant certifications and pursue additional qualifications as necessary.
- Attend workshops conferences and training sessions to stay current on the latest trends and developments in the forensic medical billing and coding field.
Qualifications :
Required Qualifications:
- 5 or more years of experience in medical billing and coding with a focus on forensic analysis and insurance claims analysis.
- 5 or more years experience with the EndToEnd Revenue Cycle Management process
- 5 or more years experience in medical record documentation review.
- Experience with complex claims analysis.
- Exceptional attention to detail and analytical skills.
- Indepth understanding of electronic health record functions and reporting capabilities.
- Experience with large data sets metadata and its analysis.
- Indepth understanding of healthcare billing processes insurance claims industry standards.
- Indepth understanding of correct coding application and regulatory guidelines.
- Certification in Medical Coding such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) BCSC (Billing coding Specialist Certification) or CMRS (Certified Medical Reimbursement Specialist (CMRS).
Additional Information :
Preferred Qualifications:
- History of expert testifying experience.
- Batchelors degree or higher in business or similar
- Familiarity with legal processes and protocols related to healthcare fraud.
- Strong written and verbal communication skills with the ability to convey complex information clearly.
- Proficiency in using medical billing software and related technologies.
- Additional Medical Certification(s) such as FMC (Forensic Medical Coding) RHIA (Registered Health Information Administrator) CPMA (Certified Professional Medical Auditor) CHDA (Certified Health Data Analyst) Certified Professional Compliance Officer (CPCO) Certified Documentation Expert Inpatient (CDEI) Certified Documentation Integrity Practitioner (CDIP) Revenue Cycle Management Specialist (RCMS)
Remote Work :
Yes
Employment Type :
Parttime
Employment Type
Remote
