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Job Summary:
Job Summary:
- On-site position; applicants must be local.
- Requires BSN or ADN degree.
- Must have an active, non-restricted South Carolina RN license.
- Must hold current CPC or CCS certification (or obtain within one year); ICD-10 proficiency required.
- Minimum 5 years’ experience in healthcare insurance (medical review, program integrity, or appeals).
- At least 5 years working with IT developers/programmers in a payer environment.
- At least 5 years’ experience with medical coding in a payer environment.
- Minimum 3 years of direct clinical experience with strong assessment and critical thinking skills.
- At least 5 years’ knowledge of ICD, CPT, HCPCS coding, and related methodologies.
- Extensive knowledge (5 years) of anatomy, physiology, pharmacology, and medical terminology.
- Preferred: 5 years’ experience in policy remediation.
- Preferred: 5 years’ experience with claims processing systems.
- Preferred: 5 years’ experience using Optum Encoder or similar medical coding software.