Claims Review Coder (CPC, CCS-P, CCA) – Managed Care
San Leandro, CA (South Oakland Area)
Coder Job Summary:
- Examine professional claims and medical records and determine appropriate payment based on national coding guidelines and Medi-Cal program
- Identify opportunities to improve coding knowledge of claims team and offer coding education or feedback to teammates
- Review medical records to ensure accuracy of diagnoses and procedures
- Apply the appropriate payment and adjustment reason to claims
- Follow and implement changes in national and state coding guidelines including new Medi-Cal benefits and procedure codes
- Requires one of the following: Certified Professional Coder (CPC) or Certified Coding Specialist – Physician-Based (CCS-P) or Certified Coding Associate (CCA).
- Around 2-3 years of a variety of coding and auditing experience, experience MUST include Medi-Cal program
- Advanced knowledge of ICD-10-CM, CPT coding, medical terminology and regulatory requirements are required.
- Able to work independently with a high degree of attention to detail and reliable decision-making abilities.
- Computer skills necessary to provide accurate medical record reviews and any corresponding documentation of results. Experience with an encoder preferred.
- Ability to maintain at least a 90% accuracy rate.