What are the responsibilities and job description for the Clinical Editing Claims Analyst position at Strategic Staffing Solutions?
Title: Medical Coding Analyst
Location: Detroit, MI (Remote/Must be local to Michigan)
Duration: 12 Month contract with chance of extending or converting to full time
W2 Pay range: $29-32/HR
Note: Must have CPC (Certified professional coder)
Occasional requests will be made to work weekends when inventory of claims is high
Role Type: Exempt
Requirements:
- 2 years of medical coding and medical billing experience is required.
- Associate degree or two years of college required with a preferred area of concentration in business, information systems or a health care related field.
- ICD 10-CM and CPT courses required; may consider two years’ experience with these manuals in lieu of classes.
- Coding certification required (eg, CPC certification).
- Minimum of four years in any combination of the following: Billing and coding experience (preferably in a comprehensive surgical center or facility), Claims resolution (including adjudication, coding, thorough analysis and problem-solving).
- Working knowledge of medical coding standards, including HCPCS, CPT, ICD-10, etc.
- Knowledge of NCQA, CMS, State and Federal HMO regulations preferred.
- Knowledge and understanding of provider coding and billing practices and systems logic for reimbursement.
Education:
- Associate’s degree in business or health care related field.
- CPC Required
Job Description:
- This position is primarily responsible for the coordination of activities within the clinical editing unit.
- This area is responsible for the development, implementation and decision-making related to the clinical editing software utilized by the health plan to determine the appropriateness of billing and reimbursement within said parameters.
- Parameters include clinical edits, multi-line surgery claims and daily limit processing (dlp), as well as related provider appeals.
Salary : $29 - $32
