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NCCI Medical Coder
Public Consulting Group
Work Setting: Consultant/Vendor
Job Function: Coder
Job Type: Contract
Salary Range: 80,000 – 130,000
Public Consulting Group is a sub-contractor to J29, Inc. (a healthcare management consulting company supporting State and Federal agencies, such as the Department of Health and Human Services). PCG is seeking a Medical Coder to provide support on the National Correct Coding Initiative (NCCI) program as an independent contractor representing PCG and reporting to J29 principles. The NCCI program is administered by the CMS, Center for Program Integrity (CPI) to minimize fraud, waste, and abuse in medical claims processing. This is an individual who will utilize their coding expertise by mitigating coding errors to prevent improper payments within federal healthcare programs of Medicare and Medicaid. This role requires excellent organizational skills and attention to detail. The ideal candidate will be comfortable not working in a coding production environment, and instead comfortable using coding knowledge to interpret subject matter expertise tasks on the program.
Demonstratable knowledge in interpreting healthcare procedures, services, drugs, and supplies into medical code sets under NCCI program
Provide continuous review of the current NCCI PTP (Procedure to Procedure), MUE (Medically Unlikely Edits) and AOC (Add-On Code) edit programs and to further develop, improve and expand those programs to prevent improper payments
Evaluate claim information to ensure that NCCI accurately reflects CMS payment and coverage policies and procedures
Reads bulletins, newsletters, and periodicals and attends working group meetings to stay abreast of issues, trends, and changes in laws and regulations governing the NCCI program and associated coding or policy requirements
Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations Organizational Relationships
Reports directly to the ASO Senior Operations Director and J29 Principle
5+ years’ experience in interpreting/coding HCPCS/CPT codes and coding conventions
Current medical coding certification (i.e., RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H minimum)
Experience working with Medicare and Medicaid payment, coverage and coding policies – preferably stakeholder engagement with mentioned policies and subject matter groups
Thorough knowledge and expertise in a remote-working environment with virtual collaboration with both internal and external groups
Preferred experience working on Federal programs with prior experience working directly with government stakeholders, with agencies such as the Centers for Medicare and Medicaid Services (CMS).
Proficient with Microsoft Office 365 (O365) applications, such as Outlook, SharePoint, Teams, Excel, OneDrive, and Word. Prefer intermediate Excel skills to include V-Lookup, pivot table creation, concatenation, etc.
Strong analytical and healthcare research skills needed
Azure SQL database experience highly desired
Education Requirement: Minimum education of a bachelor’s degree from an Accredited University or College Certified with an accredited medical coding certification, held in active standing
CMS Regulatory Research – Transmittals, Manuals 30%
New Drug HCPCS Research – Package Inserts, Dosing Parameters 15%
Data Manipulation in Excel – prepare files for Medical Director 20%
Azure SQL Database Searches 10%
CPT/HCPCS Research – understanding codes and their use 15%
Present Research Findings to NCCI Team 10%
Active Listening Skills
Attention to Detail
Open Communication with Peers – Ability to work individually and with team-members
Ability to Take Initiative with Minimal Supervision
This is a high profile, high energy and demanding environment with extended periods of computer use for claims processing and research. Often requires meeting with client and/or agency team members to discuss results of audits.
Certified through AAPC and/or AHIMA RHIA, RHIT, CCS, CCS-P, CPC
Bachelors preferred but negotiable
This is a contracted position and there are no benefits, but salary will range between $80,000 to $130,000 based on experience.
Instructions for Resume Submission
Respond to Deborah A Mueller with resume and salary requirements at email@example.com
Posted: January 12, 2024 at 4:35 PM
Post ID: 84075