Previously operated as a certified coder, coding certified by AAPC or AHIMA (CCS or CPC), with 4+ years of experience.
Understands multi-payer systems, including Medicare, Medicaid, commercial, and value-based models, and the coding impact on revenue, quality, and compliance.
Multi-dimensional expert in coding, reimbursement and grouping methodologies, CMS regulations, OIG compliance expectations, NCCI edits, local coverage determination, and audit risk.
Clinical validation and documentation judgment skills needed to evaluate provider documentation context, clinical nuances beyond coding and reimbursement guidelines, and appeals.
Ability to align with clinicians, clinical coders, and technology teams.
Middle revenue cycle consulting experience to bring broad HIM industry perspectives to the role.
Shift timings: 1.30 PM to 11 PM
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