Medical Claims Adjuster

- Analyze medical claims data to identify trends and potential financial risk across all Medicaid provider types; - Identifies procedures based on Coding Guidelines and confirms accuracy and compliance; - Conducts specialized and focused internal audits of physician and non-physician providers as well as facility-based care billing practices; - Evaluates the appropriateness of ICD-10m HCPCS and CPT codes, APC/EAPG, DRG, and modifier usage, based on medical center policies and related payor requirements; - Makes determination of overpayments and underpayments and performs other related analysis and evaluations; and Assist in developing payment models. - Minimum Qualifications for Medical Claims Adjuster 5.3.3.1 Associate Degree in Medical Billing or Medical Coding; - Minimum of three years practical experience in Medical Billing or Medical Coding; - Knowledge of the general field and basic principles, concepts, and methodology of Outpatient and Inpatient Code Sets; - Knowledge and skill sufficient to use appropriate terminology regarding coding nomenclature for inpatient and outpatient services; - Knowledge and skills in Microsoft Excel software application; - Ability to communicate both orally and in writing in order to communicate with both in-house staff and external providers; - Knowledge of laws pertaining to Protected Health Information and the penalties for unauthorized disclosures; - Strong attention to detail and a thorough understanding of medical terminology, anatomy, and physiology are essential; - Minimum of five to ten years coding experience in a healthcare setting; - Proficiency in EHR software and other billing systems is required; - Strong analytical and organizational skills; - Understanding of Alternative Payment Models (AMPs) and Bundled Payments; - Ability to analyze medical records and identify coding or billing issues; - Effective communication skills with providers, stakeholders, -  In-depth knowledge of Healthcare Common procedure Coding System (HCPCS), CPT, ICD-10-CM and ICD-10-PCS coding systems; - Associate’s or Bachelor’s degree or Certification in Certified Professional Coder (CPC), CPC CPB, BCSC, CMRS, Certified Coding Specialist (CCS); - Certified Coding Specialist (CCS) from AHIMA is preferred - Excellent communication skills in writing, oral presentations, public speaking, and computer literacy (Microsoft Word, Outlook, Excel and Power Point). - Ability to exercise tact, discretion, and skill in personal relations in dealing with persons at various levels, and groups, especially in public forum;

Salary : $20