Urgent Requirement - Certified Professional Coder

Job Description:

Title: Certified Professional Coder

Location: Ewing, NJ

Duration: Full Time

Job Summary:

This position is accountable for the review, interpretation and codification of Medical Policies and Legislative Mandates utilizing CPT-4, HCPC and ICD-9/ICD-10 coding parameters.

Responsibilities:

• Reviews and interprets current Medical Policies for systematization.

• Translates written policy interpretation into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.

• Translates Legislative Mandates into CPT, HCPC, ICD-9/ICD-10 codes for input into systems.

• Maintains a database for all policies and mandates that is updated each time new/revised/deleted CPT/HCPC/ICD-9/ICD-10 are released.

• Monitor compliance with policies and procedures relevant to clinical data reviewed.

• Perform updates to the criteria file to include adds/deletes/revisions of CPT-4 and HCPC codes. Review all codes for accuracy; review database to criteria file before implementation of policy.

• Handle internal and external areas requests to investigate current state and historical of changes made to a particular CPT-4/HCPC/Diagnosis code such as effective dates, messages used, parameter limitations.

• Review and analyze BRD/TRD/Summary to ensure accuracy of implementation of policies.

• Review of scripts concerning Edits in criteria file. Review logic concerning implementation of policies.

• Assist benefit file on criteria loading to best accommodate implementation of benefits.

• Ensure files (provider/criteria) are loaded correctly in order to receive proper Edits 405/406.

• Perform other related tasks as assigned.

Knowledge:

• Requires proficiency in the CPT-4, HCPC, ICD-9/ICD-10 coding.

• Requires knowledge of anatomy, physiology and medical terminology of medical procedures, abbreviations and terms.

• Requires knowledge of the health care delivery system.

Skills and Abilities:

• Requires the ability to utilize a personal computer and applicable software ( e.g. proficiency in Word, Excel, Access).

• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.

• Demonstrated ability to deliver highly clinical information to technical individuals.

• Must demonstrate professional and ethical business practices, adherence to company standards and a commitment to personal and professional development.

• Proven ability to exercise sound judgment and strong problem solving skills.

• Proven ability to ask probing questions and obtain thorough and relevant information.

• Must have the ability to organize/prioritize/analyze complex tasks.

• Use of CMS website for CCI rules and regulations.

• Use of other approved websites for research.

Education/Experience:

• Bachelor’s Degree preferred.

• Requires experience with McKesson ClaimsXten

• Requires a clinical medical background (Clinical editing).

• Requires a minimum of 3 years clinical experience.

• Requires 3 - 5 years of Medical Coding experience.

• Requires a minimum of 2 years’ experience in Health Insurance/Claims Processing and/or Utilization Review.

• Prefer knowledge/experience with computer processing systems.

• Requires current Registered Health Information Technologies (RHIT) or Certified Professional Coder designation from the American Academy of Professional Coders or a Certified Coding Specialist from the American Health Information Management (AHIMA).

Thanks, 

Nishit 

732-429-1639