Registered Nurse
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Job Location:
Columbia, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
12 hours ago
Vacancies:
1 Vacancy
Job Summary
Job ID: SC-9815 ()
Hybrid/Local Registered Nurse (RN & CPC/CCS & BSN/ADN must) with Medicaid Medical coding/Optum Encode clinical assessment ICD/CPT/HCPCS anatomy/physiology/pharmacology terminology claims ICD-10 experience
Location: Columbia SC (SCDHHS)
Duration: 18 Months
Work Location: Hybrid (20% onsite must be available to come onsite periodically)
Candidate Location: Candidate MUST be a SC resident. No relocation allowed.
Required Skills (rank in order of Importance):
5 years in healthcare insurance; medical review program integrity or appeals.
5 years working with IT developers/programmers in a payor environment.
5 years Medical Coding in a payer environment.
3 years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
5 years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
5 years knowledge of anatomy physiology pharmacology and medical terminology.
ADDITIONAL SKILLS:
5 years written and oral communications skills strong proficiency in English.
Preferred Skills (rank in order of Importance):
5 years experience in policy remediation.
5 years claims processing systems experience.
5 years knowledge of Microsoft Office
5 years Optum Encoder and/or other medical coding software programs
Required Education:
Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
Required Certifications:
Must have current active and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.
Specific duties include but are not limited to:
Initiates annual (and quarterly) updates from CMS of all ICD-10 CPT/HCPCS coding changes.
Performs initial review of codes to determine scope of changes.
Prepares listings of code changes to Reference Administration staff and Medicaid Program staff for review and analysis.
Conducts meetings with Agency personnel stakeholders and process owners.
(Future) Participates in DASH (Replacement MMIS) project meetings as needed where reference administration expertise is required.
Serves as an agency subject matter expert (SME) for medical coding methodologies Medicaid policy and related topics.
Research business rules requirements and models to complete initial analysis and recommendations.
Maintains business rules requirements and models in a repository.
Collaborates with the team to ensure process documentation is complete owner and stakeholder as needed training content is complete and routinely updated.
May serve as a back-up to review patient records against established criteria to determine medical necessity.
Other project-related duties.
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Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
