We are seeking a Billing and Coding Specialist to join our Medical Records and Billing team. This is a unique opportunity for an entrepreneurial, highly drive person with a well - rounded skill set whose responsibilities extend beyond those of traditional roles. The ideal person for this role will need a strong  grasp of the medical billing and coding sector, be flexible and intuitive, as well as being  a strategic thinker able to take on a variety of tasks.

Key Responsibilities:

1. Research Review:

a. Perform comprehensive review and research surrounding coding and billing records, industry standards, deep medical records review and analysis, and associated documents to identify inaccuracies, misrepresentations, or instances of potential fraud.

b. Evaluate and interpret CPT, ICD, HCPCS, and other relevant coding systems to pinpoint discrepancies or inaccuracies.

c. Understand and navigate EHR systems and billing software. Assist with internal or external audits regarding billing and documentation.

2. Legal Expert Support:

a. Serve as an administrative and research support to senior level experts.  

3. Documentation & Reporting:

a. Document findings clearly and concisely, generating reports detailing discrepancies, overcharges, or potentially fraudulent activity. 

b. Collaborate with legal and compliance teams, providing them with detailed evidence and data-backed insight for potential legal proceedings.

4. Compliance & Best Practices:

a. Stay updated on the latest medical coding and billing regulations, ensuring all analyses align with current standards and best practices.

b. Advise medical and administrative teams on compliance requirements and potential areas of risk.

5. Collaboration & Consultation:

a. Work closely with healthcare providers, insurance companies, healthcare industry, and legal entities to provide support in all related medical billing and coding matters, UCR rates, proper documentation, and methodology.

b. Serve as a consultant to payer sources and attorneys, offering guidance on best practices and potential areas of improvement.

6. Continued Education:

a. Attend workshops, conferences, and training sessions to stay current on the latest trends and developments in the forensic medical billing and coding field.

b. Maintain relevant certifications and pursue additional qualifications as necessary.

Required Qualifications:

• 3 or more years of experience in medical billing and coding, with a focus on forensic analysis and insurance claims analysis.
• 3 or more years’ experience with the End-To-End Revenue Cycle Management process
• 3 or more years’ experience in medical record documentation review.
• Experience with complex claims analysis.
• 3 or more years' experience with healthcare compliance.
• 3 or more years' experience with provider and payer audits.   
• Exceptional attention to detail and analytical skills.
• In-depth understanding of electronic health record functions and reporting capabilities. 
• Experience with large data sets, metadata, and its analysis.
• In-depth understanding of healthcare billing processes, insurance claims, and industry standards.
• In-depth understanding of correct coding applications, compliance, and regulatory guidelines.
• Certification in Medical Coding, such as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist), BCSC (Billing coding Specialist Certification), or CMRS (Certified Medical Reimbursement Specialist (CMRS).

Preferred Qualifications:

• History of expert testifying experience preferred but not required for this analyst level.
• Bachelor's degree in health science, Business Admin, Nursing or similar; OR
• Industry standard training and experience along with certifications and/or credentials equating to a bachelor's degree or higher.
• Familiarity with legal processes and protocols related to healthcare fraud.
• Strong written and verbal communication skills, with the ability to convey complex information clearly.
• Proficiency in using medical billing software and related technologies.
• Additional Medical Certification(s) such as FMC (Forensic Medical Coding), RHIA (Registered Health Information Administrator), CPMA (Certified Professional Medical Auditor), CHDA (Certified Health Data Analyst), Certified Professional Compliance Officer (CPCO), Certified Documentation Expert Inpatient (CDEI), Certified Documentation Integrity Practitioner (CDIP), Revenue Cycle Management Specialist (RCMS) preferred.

Physical and Mental Job Qualifications

• Travel as needed

Additional Information

Some of the Benefits We Have Include

J.S. Held understands all our employees are people and sometimes life needs flexibility. We work to always provide an environment that best supports and suits our team’s needs.

• Our flexible work environment allows employees to work remotely, when needed
• 401k Match

A reasonable estimate of the salary range for this role is $40/hr - $45/hr. Any offered salary range is based on a wide array of factors including but not limited to skillset, experience, training, location, scope of role, management responsibility, etc.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

By submitting your application, you acknowledge that you have read the J.S. Held Online Privacy Notice and hereby freely and unambiguously give informed consent to the collection, processing, use, and storage of your personal information as required and described therein. California residents can click here to learn more about the personal information we collect and here to learn about additional privacy rights that may be available.

Please explore what we’re all about at www.jsheld.com.

EEO and Job Accommodations

We embrace diversity and our commitment to building a team and environment that fosters professional and personal enrichment is unwavering. 

J.S. Held is an equal opportunity employer. Qualified applicants are considered for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you are an individual with a disability and would like to request a reasonable accommodation during the recruitment process, please email [email protected]. Include "Applicant Accommodation" in the subject line, along with your request and contact information.

All your information will be kept confidential according to EEO guidelines.

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