Medical Coding Consultant-Risk Optimization

Baton Rouge, LA 70801 | Temporary

Post Date: 06/12/2018 Job ID: 00004MPB Industry: Clerical Pay Rate: 0.00
Spherion has an opening for a Medical Coding Consultant-Risk Optimization

Job Description:

Conducts medical record reviews and coordinates adjustments for Diagnostic Accuracy/Risk Adjustment methodology and HEDIS abstractions. Provides written medical coding expert-level responses to internal and external customer requests and third party vendors for clarification of medical coding issues, clinical editor bundling and filtering, medical coding policy, regulatory agency policy and coding-related reimbursement and medical policy issues, in a prompt and efficient manner to support medical coding-related activities at BCBSLA.

Oversees medical record chart retrieval processes including, but not limited to: Prepares daily reports to prioritize chart retrieval processes. Directs and prioritizes other BCBSLA medical record retrievers' tasks. Works closely with chart retrieval vendors to ensure timelines are met. Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records. Documents conversations with provider offices and vendors, and tracks outcomes. Scans and tags medical records into document management system. Queries and identifies relevant medical records within (but not limited to) document management system, care management system, and vendor(s) databases.


A minimum of 5 years current hands-on clinical or consultant-level experience with in-depth research, analysis and application of CPT, HCPCS, and ICD-10-CM coding, billing and reimbursement guidelines for Medicare or private payers is required. Understanding of Diagnostic Accuracy/Risk Adjustment and/or HEDIS/STARS is preferred.

Certified professional coding credentials for CPT, HCPCS, and ICD-10-CM medical coding systems is required.

Strong body of knowledge regarding disease processes and medical and surgical procedures is required. Knowledge and understanding of medical terminology is required. Experience in medical record auditing / review is preferred.

Extensive experience with provider billing practices, American Medical Association coding guidelines, Correct Coding Initiative edits, Physician Specialty guidelines, payor reimbursement programs, claims adjudication processes, and regulatory agency policies (CMS/HCFA) is required.

Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) is preferred

Experience with large scale medical record retrieval is preferred.

Proficiency with Microsoft Excel and Word is required.


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