At Health Care Excel, we are a recognized strategic partner in leading the transformational change of quality and integrity of health care systems by providing leading-edge services and expertise. By offering innovative solutions we improve health care systems and information; enhance the quality of care; and improve patient outcomes. Working with our partners we provide clinically based, objective, and independent monitoring of the quality, appropriateness, and medical necessity of health care services to safeguard against waste, fraud, and abuse. Our expertise in working with consumers, government programs, health care providers and plans is unsurpassed.
Health Care Excel offers a fast-paced, entrepreneurial environment dedicated to continual improvement. Core competencies for the organization include accountability, business minded, customer focused, delivering results, ethics & values, and fun & positive. Candidates with a passion for growth, development, and innovation will find a career at Health Care Excel a very rewarding experience.
The Medical Coder – Utilization Management is responsible for conducting a detailed review of inpatient and /or outpatient medical records to assess the accuracy and appropriateness of the recorded medical coding for proper diagnosis, procedure, and revenue codes. This position also provides a detailed written summary of the rationale used when coding corrections are required.
- Perform a detailed review of the inpatient/outpatient medical records to validate that the ICD-9 diagnosis and procedure codes were coded and sequenced correctly to achieve the appropriate MS-DRG, AP-DRG, and/or APR-DRG based on identified review criteria.
- Conduct quality audits for and provide feedback to consultant coding reviewers and gather information for inter-rater reliability measures.
- Provide a detailed rationale and/or written summary to make adjustments to correct improperly paid claims and document the correct coding to be utilized.
- Prepare management summary reports of findings and assist in providing feedback and remediation to consultant reviewers.
- Review claim to chart, to determine if services are billed appropriately and supported by documentation in medical records.
- Document review findings in designated review database(s).
- Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) required
- Experience with compliance and/or denial management preferred
- Experience in clinical role desired (i.e. respiratory therapy, radiology technician, surgery technician, etc.)
- Minimum four years coding experience
- Minimum two years utilization management experience preferred
- Knowledge of ICD-10 preferred
- Experience in dental coding desired
- Possess medical knowledge, skills and abilities to identify non-compliance in areas of coding practices and medical record documentation.
- Able to work independently with a strong attention to detail and reliable decision-making abilities.
- Excellent oral and written communication skills.
- Strong computer skills to process reviews electronically utilizing proprietary software.
- Knowledge of HCC (Hierarchical Condition Categories).
- Ability to handle PHI in a professional manner and maintain HIPAA compliance
Onsite in our Plainfield, Indiana office