Job Information
Insight Global Exclusive Remote Medical Reviewer (CPC, Outpatient, Profee, E/M) in Eden Prairie, Minnesota
Job Description
Our client is looking for 3 contract resources to start as 6-month contracts. They will be responsible to investigate the client's Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedures to determine the viability of the claim for further review in a production environment. This is not a hands-on medical coding role, rather more of a reviewer type position.
Perform clinical review of professional claims vs. medical records to determine if the claim is supported or unsupported. Will be working with the client's External Commercial team consisting of other certified coders.
Top Responsibilities:
Clinical Case Reviews -75%
Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported.
Maintain standards for productivity and accuracy. Standards are defined by the department.
Provide clear and concise clinical logic to the providers when necessary.
Other internal customer correspondence and team needs 15%
Attend and provide feedback during monthly meetings with assigned internal customer department.
Provide continuous feedback on how to improve department relationships with internal team members and departments.
Continue education 10%
Keep up required Coding Certificate and/or Nursing Licensure.
Complete compliance hours as required by the department.
What software tools/skills are needed to perform these daily responsibilities? Microsoft Office Excel, Outlook, etc.
How will performance be measured? monthly audits of reviewed work with a 95% or higher accuracy rate for goal and a charts per hour metric of 3.8
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .
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Skills and Requirements
Must be able to pass the preassessment with 94% (1 incorrect) or higher, no retakes
Active Certified Professional Coder (CPC) certification and profee coding experience
3 years former coding experience or auditing experience
NCCI/CCI edits experience
Outpatient professional coding experience
Evaluation & management (E/M) coding experience
Ability to work remotely from home in a home office space with a door
Ability to have childcare and not be the primary childcare for child(ren) at home (if applicable)
Ability to hardwire into their internet from a modem or router via ethernet cable.
Ability to work from one home location (not another home/business) unless pre-approved by manager.
Ability to miss none or minimal days during the 3 month training period.
Only possess this coding position, as it is against their contractual agreement with their clients for them to have another coding position outside of this position.
Soft skills
Working knowledge of medical terminology and claim coding.
Strong written and verbal communications skills.
Strong customer service skills.
Ability to work in a team.
Proficient with personal computers null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.