Senior Medical Coding Specialist

Summary

Join Blue Water Thinking as a Senior Medical Coding Specialist and contribute to data-driven solutions that enhance the U.S. healthcare system. You will leverage your expertise in medical coding, billing, and provider reimbursement to analyze claim data, audit medical records, and support the development of machine learning models. This role involves collaborating with data science teams, designing continuous improvement programs, and presenting findings to clients. The ideal candidate possesses extensive knowledge of medical coding practices, reimbursement methodologies, and claim edits, along with strong communication skills. A minimum of five years of experience and relevant certifications are required. Blue Water Thinking offers a competitive salary and a comprehensive benefits package.

Requirements

• Minimum of five years experience in the areas of medical coding and provider audit is required
• Professional Coding certification by the American Academy of Professional Coders or the American Health Information Management Association
• Coding experience in a Health Care system is required
• Extensive knowledge of medical claim edits is required
• Hands-on knowledge of physician and hospital reimbursement methodologies including Medicare, Medicaid, and commercial coding practices is required
• Strong written and verbal communication skills
• Strong knowledge of Microsoft Office products is required
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Must be able to obtain and maintain the required federal public trust clearance for this role

Responsibilities

• Claim data analysis to identify anomalies
• Audit medical record documentation to identify incorrectly reported services, procedures, ICD-10, HCPCS, CPT-4 codes, DRG and OPPS
• In coordination with our data science teams, assist in designing and deployment of continuous improvement programs
• Assist in the development and validation of the payment integrity machine learning models. These advanced computational models are responsible for the identification of claims payment anomalies, coding errors, contract misinterpretations, or internal processing payment errors
• Participate in brainstorming sessions, finalization, and creation of presentation of client-specific solution recommendations
• Document and communicate results of validation to clients and perform necessary follow-up

Preferred Qualifications

• Knowledge of Redshift and SQL is desired
• Bachelor’s degree in a health related field or quantitative discipline is desired
• RN/LVN is preferred

Benefits

• Health insurance (medical, dental and vision)
• Paid time off
• Federal holidays
• Matching 401K plan