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Claims Review Coder

San Leandro, CA · Administrative
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
Coder Background:
  • 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.

443.552.7423 (CALL – TEXT – FAX)
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