Medical Coding Specialist

About Claritev

Claritev is a dynamic team of innovative professionals dedicated to bending the cost curve in healthcare. The company strives for service excellence with all stakeholders, emphasizing bold innovation, accountability, diversity, and empowerment.

Job Summary

The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. This role involves performing bill and chart reviews to identify variations from quality billing practices and monitoring patient bills for accuracy and compliance, with awareness of international coding systems and healthcare billing practices.

Key Responsibilities

• Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analyze charges across various revenue centers considering patient diagnosis, procedures, age, facility type, and international healthcare norms
• Apply recommendations of national and international coding standards (e.g., ICD-10-AM, OPCS-4, SNOMED CT) to claims billed
• Prepare clear, concise findings including documentation for cross-border audits or international compliance reviews
• Research and review itemized bills, claims, operative notes, and other documentation, including those from international providers or translated medical records
• Assist with creating or enhancing internal claim and review recommendations
• Communicate with co-workers and management regarding clinical and reimbursement findings
• Provide clinical education to staff regarding claims and industry or regulatory changes
• Monitor, research, and summarize trends, coding practices, and regulatory changes across multiple countries or regions
• Collaborate across disciplines and departments
• Ensure compliance with HIPAA and international data protection regulations (e.g., GDPR, PIPEDA)