Reports to: Professional Medical Solutions Director

Direct Reports: None

FLSA: Hourly, Non-Exempt

Essential Functions

• Reviews clinical medical records for supporting documentation of billed charges.
• Provides coding review feedback to medical bill review expert witness consultants.
• Uses medical services valuation methods and benchmarks to determine reasonable value of services provided and analyzes future surgical cost estimates and life care plans.
• Provides written report thoroughly explaining the reasonable value analysis.
• Contributes thoughtfully to a growing team of professionals who respect each other and promote each other in providing a unique and significant service to our healthcare system
• Additional duties, responsibilities and projects as assigned

Required Experience

• Knowledge of medical coding billing and payment processes; AMA CPT and HCPCS billing, clinical documentation requirements, claims processing, payment posting, and claims follow-up for patients with insurance and patients without insurance.
• Medical office or facility coding and billing tasks

Education

Entry Level Position Requirements:

• A high school diploma or equivalent.
• 3-5 years of medical billing experience and/or 3-5 years of medical coding experience
• Proficiency in Microsoft suite

Professional Level Position Requirements:

• Qualifying Healthcare Operations and/or Healthcare Financial Management Experience
• Certifications as a coder are beneficial

Competencies

• Problem-Solving - Resolves problems by identifying the information needed, considering multiple sides of the issue, and creating a logical approach for an appropriate solution.
• Critical Thinking - Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Analytical - Uses a logical reasoning process to break down and work through a situation, data, or problem to arrive at an outcome.
• Communication - Actively listens and provides regular, consistent, and meaningful information and expresses the message effectively by organizing and delivering information appropriately.
• Customer Service - Commitment to delivering high quality service by adjusting priorities, anticipating next steps, meeting client needs, and continuously striving to ensure their satisfaction.
• Organization - Determines priorities, schedules activities allocating and using resources effectively and efficiently.
• Detail-Oriented - Achieves thoroughness and accuracy when accomplishing a task through concern for all the areas involved with the ability to verify the correctness or error in each individual part of procedure.
• Time Management - Manages time by prioritizing and organizing workload to achieve maximum productivity and adjusting as situations change.
• Flexibility - Open to new ideas, a fast-paced and often-changing environment, and new information or assignments. Changes methods of approach when necessary to achieve a goal.
• Teamwork - Promotes and facilitates cooperation and commitment within a team and across teams to achieve goals and deliverables.
• Positive Attitude - Has a willingness to learn with a “can-do” mindset.
• Discretion - Is able to be discreet and maintain the security of customer and company information.

Work Environment

This job operates in a professional office environment. This is largely a sedentary role. The role routinely uses standard office equipment such as computers, data sources, phones, and photocopiers.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms. The position requires the ability to occasionally lift office products and supplies, up to ten (10) pounds.

Travel

Travel may be required for this role up to 10%.

Equal opportunity

Medical Equation is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics. 

Disclaimer:

This job description does not necessarily include every responsibility, requirement, skill, or working condition associated with this role. This description is intended to reflect the role currently and management will revise the role, as needed, and may require that different tasks be performed, in order to meet the needs of the business.