Medical Case Reviewer I - Maximus

Maximus is looking for a Part Time Remote Medical Coder. The Medical Coder Position will administer and process all incoming medical records and lay evidence included with a proposal to ensure correct documents are provided to the WCMSA reviewer.

Essential Duties and Responsibilities:
- Administer and process all incoming medical records and lay evidence included with a proposal.
- Ensure correct documents are provided to the reviewer.
- Review documents determining completeness and eligibility prior to assigning to the reviewer.
- Examine case file to ensure all relevant information has been submitted.
- Contact appropriate parties for required documents and/or clarification, if not received.
- Succinctly summarize the facts for each case for the reviewer indicating what medical evidence is present supporting the set-aside proposal.
- Work closely with SMEs to develop and implement internal procedures, policy communications, work flows, QC documents, training materials and job aids.

- Abstract and code clinical data.

- Expertise with inpatient and outpatient coding; ICD-9 CM and ICD-10 codes; Current Procedural Terminology (CPT) codes; and Healthcare Common Procedure Coding System (HCPCS) practices.

- Audit medical records to ensure compliance with the organization's coding procedures and standards.

- Accurately enter coded data in systems and validate data entered.

- Research correct coding practices, clearly document and share findings with others.

- Serves as a resource and subject matter expert to project staff.

- Communicate with team members either through discussion or in writing (e.g., formal queries) regarding missing, unclear, or conflicting medical record documentation and policies to obtain clarification to provide accurate decisions/recommendations.

- Recommend and suggest improvements to assigned projects.

- Attend meetings when necessary to provide coding expertise when requested by Management.

- Assume responsibility for professional development to maintain required credentials.

- Keep current with changes in coding guidelines, Medicare coverage guidelines, compliance, reimbursement, and other relevant regulatory updates.

- Adhere to internal controls and reporting structure.

- Comply with all relevant policies, procedures and other regulatory, compliance and accreditation standards.

- Contribute to a positive working environment and perform other duties as assigned or directed to enhance the overall efforts of the organization.

- High School diploma or equivalent with 0-2 years of experience.

- Associate degree preferred.

- AHIMA or AAPC professional coders credentialing required (RHIT, CCS, CCS-P, CPC, CRC).

- Proficient in Microsoft Office, with accurate data entry skills.

- Strong organizational, interpersonal, written, and verbal communication skills.

- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.

- Ability to successfully execute many tasks simultaneously.

- Work as a team member as well as independently.

Home Office Requirements:

- Hardwired internet (ethernet) connection

- Internet download speed of 25mbps and 5mbps (10 preferred) upload or higher required (you can test this by going to www.speedtest.net )

- Private work area and adequate power source

Minimum Requirements

- High School diploma or equivalent with 1-2 years of experience.
- Associate degree preferred.

- Associate degree preferred.

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation.