e4 Services is a leading national healthcare consulting and professional services company providing Revenue Cycle, HIM, CDI, Coding, Clinical Optimization and IT solutions.
We also specialize in complex program and change management. At e4 Services, we understand that happy employees mean happy customers. Our goal is to create and maintain a company culture that fosters an innovative and fun spirit for our team.
Our team members come from many diverse backgrounds and professional experiences, but we are all connected by a shared goal of improving healthcare.
- This is a Full-Time role based out of the Philadelphia area, with at least two days onsite for meetings and the rest working remotely from home.
- Medical coding consultants work to ensure accurate coding of the clinically documented care within medical records. They utilize industry coding guidelines along with specialized medical classification software to assign procedure and diagnosis codes for insurance billing.
- This individual has the responsibility for developing, implementing and maintaining a data quality compliance plan for inpatient and outpatient coding.
- They’ll also perform daily audits to validate accuracy of MSDRG, APC and coding assignments to ensure compliance with coding requirements.
- Responsible for developing, applying and upholding a coding quality compliance plan for outpatient and inpatient coding
- Organizes and conducts daily reviews of targeted cases to ensure correct hospital reimbursement
- Complete random audits and reviews on denied cases to validate accuracy of MS-DRG and APC coding assignments to ensure compliance with coding and billing requirements
- Perform follow-up and focused audits as directed and as necessary
- Ensures optimal reimbursement of all cases in compliance with CMS policies and procedures and ICD-10-CM and ICD-10-PCS Official Coding Guidelines
- Utilizes technical coding principals and DRG and/or APC reimbursement expertise to assign appropriate diagnoses and/or procedures
- Fluent in Official Coding Guidelines, Coding Clinics and reimbursement reporting requirements.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association
- Adheres to Client’s policies and procedures
- Ability to review Medicare and other payer claims and denials and document validity of payer findings
- Appropriately identify payer denials issues and determine correct resolution
- Research and prepare appeal letters with appropriate coding guidelines and rationales
- Ability to work collaboratively with all departments involved in the revenue cycle claims process
- Provides constructive feedback to the customer on areas of opportunity and coding and reimbursement risk
- Ensures client’s production and overall expectations are met
- Minimum of 3 years of coding and facility auditing experience
- Strong knowledge of denials management, validation and appeals process
- Satisfactory completion of e4 ICD-10-CM and PCS test – 85 or above on both CM and PCS.
- Demonstration of successful completion of ICD-10-CM and PCS coursework with experience production coding of hospital inpatient in ICD-10-CM and PCS.
- Experience with remote EHR access and encoder preferred; Technical skill set sufficient to sustain independent remote working environment, including PC troubleshooting, program installation.
- Proficiency in MS Office, including Outlook, Word, Excel and PowerPoint.
- Experience in working with large academic facilities is preferred
- Computer Assisted Coding (CAC) experience desired
- Self-starter with strong interpersonal, analytical and critical thinking skills.
- Learns quickly and adapt to change.
- AHIMA and/or AAPC credentialed CCS, CPC required with RHIT/RHIA preferred
- Bachelor’s degree preferred
- We offer healthcare benefits with employer sponsored HSA
- Employer sponsored short and long term disability and life insurance
- 401K with employer 4% match.
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